Provider Demographics
NPI:1700316288
Name:THE SLEEP LAB, LLC
Entity Type:Organization
Organization Name:THE SLEEP LAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:ROYCE
Authorized Official - Last Name:HAMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT, RST
Authorized Official - Phone:228-234-0521
Mailing Address - Street 1:162 HOUSTON ACRES
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MS
Mailing Address - Zip Code:39073-9708
Mailing Address - Country:US
Mailing Address - Phone:228-234-0521
Mailing Address - Fax:
Practice Address - Street 1:162 HOUSTON ACRES
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MS
Practice Address - Zip Code:39073-9708
Practice Address - Country:US
Practice Address - Phone:228-234-0521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic