1679624209 NPI number — VITAL SLEEP, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679624209 NPI number — VITAL SLEEP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VITAL SLEEP, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WELLNECESSITIES OF DALLAS
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679624209
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8835 LINE AVE
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71106-6722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-222-0885
Provider Business Mailing Address Fax Number:
318-222-0883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9707 ANDERSON MILL RD
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78750-2298
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-222-0885
Provider Business Practice Location Address Fax Number:
318-222-0883
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DESMARTEAU
Authorized Official First Name:
LEA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
318-222-0885

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X , with the licence number:  0076806 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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