| Organization Name: | MOTHERLODE SLEEP CENTER INC |
| NPI Number: | 1093965493 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRAD LEE BERRYMAN (PRESIDENT/CEO) |
| Mailing Address: | 729 Pauline Ct Sonora |
| State: | CA US |
| Postal Code: | 95370 |
| Phone Number: | 2095888068 |
| Fax Number: | |
| NPI Enumeration Date: | 09/23/2008 |
| NPI Last Update Date: | 09/23/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QS1200X |
| License Number: | A79487 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Sleep Disorder Diagnostic |
| Taxonomy Definition: | |