=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730803859
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMFORT COVE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2022
-----------------------------------------------------
Last Update Date | 06/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8924 JEWELLA AVE STE 321
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71118-2100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-828-1943
-----------------------------------------------------
Fax | 318-217-6887
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8924 JEWELLA AVE STE 321
-----------------------------------------------------
City | SHREVEPORT
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71118-2100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-828-1943
-----------------------------------------------------
Fax | 318-217-6887
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | LETATIA R VANCE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 318-572-6606
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 385H00000X
-----------------------------------------------------
Taxonomy Name | Respite Care
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------