Healthcare Provider Details

I. General information

NPI: 1295878346
Provider Name (Legal Business Name): SLEEP DISORDER CENTER OF LOUISIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 LAKE ST
LAKE CHARLES LA
70605-6010
US

IV. Provider business mailing address

PO BOX 4591
LAKE CHARLES LA
70606-4591
US

V. Phone/Fax

Practice location:
  • Phone: 337-310-7378
  • Fax: 337-310-7382
Mailing address:
  • Phone: 337-436-7560
  • Fax: 337-433-9861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number2342
License Number StateLA

VIII. Authorized Official

Name: SHEILA ROBERSON
Title or Position: CCO
Credential:
Phone: 443-707-2228