Provider Demographics
NPI:1912080219
Name:VITAL SLEEP, LLC
Entity Type:Organization
Organization Name:VITAL SLEEP, LLC
Other - Org Name:WELLNECESSITIES OF DALLAS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESMARTEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-222-0885
Mailing Address - Street 1:8835 LINE AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-6722
Mailing Address - Country:US
Mailing Address - Phone:318-222-0885
Mailing Address - Fax:318-222-0883
Practice Address - Street 1:9707 ANDERSON MILL RD STE 150
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-2298
Practice Address - Country:US
Practice Address - Phone:318-222-0885
Practice Address - Fax:318-222-0883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0076806A332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3457215OtherCIGNA PROVIDER NUMBER
TX531029OtherBCBS DME PROVIDER NUMBER
TX7365296OtherAETNA PROVIDER NUMBER
TXPL7071OtherBCBS DX PROVIDER NUMBER
TX7365296OtherAETNA PROVIDER NUMBER