Provider Demographics
NPI:1174841837
Name:SLEEP RESTORATION CENTER, LLC
Entity Type:Organization
Organization Name:SLEEP RESTORATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:JENNINGS
Authorized Official - Last Name:CHRYSANTHOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:318-450-3378
Mailing Address - Street 1:2807 EVANGELINE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3749
Mailing Address - Country:US
Mailing Address - Phone:318-450-3378
Mailing Address - Fax:318-324-1719
Practice Address - Street 1:2807 EVANGELINE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3749
Practice Address - Country:US
Practice Address - Phone:318-450-3378
Practice Address - Fax:318-324-1719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic