Healthcare Provider Details

I. General information

NPI: 1932361615
Provider Name (Legal Business Name): RED RIVER SLEEP CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 WINDERMERE BLVD
ALEXANDRIA LA
71303-3538
US

IV. Provider business mailing address

223 WINDERMERE BLVD
ALEXANDRIA LA
71303-3538
US

V. Phone/Fax

Practice location:
  • Phone: 318-443-1684
  • Fax: 318-427-3303
Mailing address:
  • Phone: 318-443-1984
  • Fax: 318-427-3303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License Number
License Number State

VIII. Authorized Official

Name: RODNEY PENNER
Title or Position: DIRECTOR OF OPERATIONS
Credential: LPN, RPSGT, LPSGT
Phone: 318-443-1684