Provider Demographics
NPI:1194900126
Name:GOOD NIGHT SLEEP CENTER LLC
Entity type:Organization
Organization Name:GOOD NIGHT SLEEP CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:IMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-513-5522
Mailing Address - Street 1:425 E US RT 6
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450
Mailing Address - Country:US
Mailing Address - Phone:815-513-5522
Mailing Address - Fax:815-942-6582
Practice Address - Street 1:115 E NORTH ST
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450
Practice Address - Country:US
Practice Address - Phone:815-513-5522
Practice Address - Fax:815-942-6582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic