Provider Demographics
NPI:1922770379
Name:SLEEP CARE CLINIC LLC
Entity Type:Organization
Organization Name:SLEEP CARE CLINIC LLC
Other - Org Name:SLEEP CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING AND CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-381-4759
Mailing Address - Street 1:7600 FERN AVE STE 700A
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5673
Mailing Address - Country:US
Mailing Address - Phone:318-657-0187
Mailing Address - Fax:318-404-1510
Practice Address - Street 1:7600 FERN AVE STE 700A
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5673
Practice Address - Country:US
Practice Address - Phone:318-657-0187
Practice Address - Fax:509-426-2160
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SARAMED LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-04
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3604116Medicaid