Healthcare Provider Details

I. General information

NPI: 1730803859
Provider Name (Legal Business Name): COMFORT COVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8924 JEWELLA AVE STE 321
SHREVEPORT LA
71118-2100
US

IV. Provider business mailing address

8924 JEWELLA AVE STE 321
SHREVEPORT LA
71118-2100
US

V. Phone/Fax

Practice location:
  • Phone: 318-828-1943
  • Fax: 318-217-6887
Mailing address:
  • Phone: 318-828-1943
  • Fax: 318-217-6887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL

VIII. Authorized Official

Name: LETATIA R VANCE
Title or Position: ADMINISTRATOR
Credential:
Phone: 318-572-6606