Provider Demographics
NPI:1871887638
Name:AMAZING SLEEP, LLC
Entity type:Organization
Organization Name:AMAZING SLEEP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-684-9002
Mailing Address - Street 1:PO BOX 397
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37162-0397
Mailing Address - Country:US
Mailing Address - Phone:931-684-9002
Mailing Address - Fax:931-684-9007
Practice Address - Street 1:213 LANE PKWY
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-3108
Practice Address - Country:US
Practice Address - Phone:931-684-9002
Practice Address - Fax:931-684-9007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
4308720OtherBCBS
TN1524463Medicaid