Basic Information
| Provider Information | |||||||||
| NPI: | 1093823890 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HARBOR HOSPICE OF LAKE CHARLES, LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3406 COLLEGE ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BEAUMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 777014612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4098132332 | ||||||||
| FaxNumber: | 4092320573 | ||||||||
| Practice Location | |||||||||
| Address1: | 5210 LAKE ST | ||||||||
| Address2: | |||||||||
| City: | LAKE CHARLES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706056574 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3375628620 | ||||||||
| FaxNumber: | 3375628621 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 04/09/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CARTER | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXEC ADMIN ASST | ||||||||
| AuthorizedOfficialTelephone: | 4097302046 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 185 | LA | N | Agencies | Hospice Care, Community Based | 251G00000X | 19-1625 | LA | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 1582417 | 05 | LA | MEDICAID | 185 | 01 | LA | DHH | OTHER |