Basic Information
| Provider Information | |||||||||
| NPI: | 1720144942 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEALTH CARE OPTIONS HOSPICE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6639 SULLIVAN RD | ||||||||
| Address2: | |||||||||
| City: | GREENWELL SPRINGS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707393112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252616314 | ||||||||
| FaxNumber: | 2252610226 | ||||||||
| Practice Location | |||||||||
| Address1: | 6639 SULLIVAN RD | ||||||||
| Address2: | |||||||||
| City: | GREENWELL SPRINGS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707393112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252616314 | ||||||||
| FaxNumber: | 2252610226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2006 | ||||||||
| LastUpdateDate: | 01/29/2008 | ||||||||
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| AuthorizedOfficialLastName: | MCCRARY | ||||||||
| AuthorizedOfficialFirstName: | MAXINE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF OPERATION | ||||||||
| AuthorizedOfficialTelephone: | 2252616314 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | NURSE | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 1582433 | 05 | LA | MEDICAID |