Healthcare Provider Details

I. General information

NPI: 1104095603
Provider Name (Legal Business Name): AWAKENING SLEEP CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 S 5TH ST SUITE B
LEESVILLE LA
71446-5304
US

IV. Provider business mailing address

1608 S 5TH ST SUITE B
LEESVILLE LA
71446-5304
US

V. Phone/Fax

Practice location:
  • Phone: 337-392-5910
  • Fax: 337-392-1099
Mailing address:
  • Phone: 337-392-5910
  • Fax: 337-392-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JENNIFER R BOYD
Title or Position: MANAGER
Credential:
Phone: 337-392-5910