Basic Information
| Provider Information | |||||||||
| NPI: | 1942302153 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOSPICE CARE OF LOUISIANA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 CADILLAC DR | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370275078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154255407 | ||||||||
| FaxNumber: | 6153734457 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 W CAUSEWAY APPROACH | ||||||||
| Address2: | |||||||||
| City: | MANDEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704713043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9856398000 | ||||||||
| FaxNumber: | 9856398212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2006 | ||||||||
| LastUpdateDate: | 03/12/2018 | ||||||||
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| AuthorizedOfficialLastName: | ADKINS | ||||||||
| AuthorizedOfficialFirstName: | RUSSELL | ||||||||
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| AuthorizedOfficialTitleorPosition: | SVP GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 6153095668 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 121 | LA | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 1580830 | 05 | LA | MEDICAID |