Healthcare Provider Details

I. General information

NPI: 1417109380
Provider Name (Legal Business Name): COMFORT AND JOY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 N THOMAS DR
SHREVEPORT LA
71107-6519
US

IV. Provider business mailing address

211 N THOMAS DR
SHREVEPORT LA
71107-6519
US

V. Phone/Fax

Practice location:
  • Phone: 318-670-3933
  • Fax:
Mailing address:
  • Phone: 318-703-6578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number220378109
License Number StateLA

VIII. Authorized Official

Name: STACY JACKSON
Title or Position: OWNER
Credential:
Phone: 318-670-3933