Provider Demographics
NPI:1649400664
Name:COMFORT SLEEP CENTER OF LOUISIANA INC
Entity Type:Organization
Organization Name:COMFORT SLEEP CENTER OF LOUISIANA INC
Other - Org Name:COMFORT SLEEP CENTER OF LOUISIANA INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DIETRICH
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-245-7964
Mailing Address - Street 1:11201 IVY LN
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70128-2915
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11201 IVY LN
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70128-2915
Practice Address - Country:US
Practice Address - Phone:504-245-7964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMFORT SLEEP CENTER OF LOUISIANA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory