Provider Demographics
NPI:1730803859
Name:COMFORT COVE LLC
Entity type:Organization
Organization Name:COMFORT COVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LETATIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-572-6606
Mailing Address - Street 1:8924 JEWELLA AVE STE 321
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-2100
Mailing Address - Country:US
Mailing Address - Phone:318-828-1943
Mailing Address - Fax:318-217-6887
Practice Address - Street 1:8924 JEWELLA AVE STE 321
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-2100
Practice Address - Country:US
Practice Address - Phone:318-828-1943
Practice Address - Fax:318-217-6887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No385H00000XRespite Care FacilityRespite Care
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities