Basic Information
| Provider Information | |||||||||
| NPI: | 1780786590 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY HOSPICES OF AMERICA, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | COMMUNITY HOSPICES OF AMERICA - SHREVEPORT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3500 BLUE LAKE DR | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352431907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059708888 | ||||||||
| FaxNumber: | 2059688199 | ||||||||
| Practice Location | |||||||||
| Address1: | 8660 FERN AVE | ||||||||
| Address2: | SUITE 145 | ||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711055649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185241046 | ||||||||
| FaxNumber: | 3185242166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2006 | ||||||||
| LastUpdateDate: | 11/01/2007 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HUNTER | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | B. | ||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR VICE-PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2059708888 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 178 | LA | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 1584169 | 05 | LA | MEDICAID |