Provider Demographics
NPI:1104095603
Name:AWAKENING SLEEP CENTER LLC
Entity type:Organization
Organization Name:AWAKENING SLEEP CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-392-5910
Mailing Address - Street 1:1608 S 5TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-5304
Mailing Address - Country:US
Mailing Address - Phone:337-392-5910
Mailing Address - Fax:337-392-1099
Practice Address - Street 1:1608 S 5TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-5304
Practice Address - Country:US
Practice Address - Phone:337-392-5910
Practice Address - Fax:337-392-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DA78Medicare PIN