Healthcare Provider Details

I. General information

NPI: 1982704219
Provider Name (Legal Business Name): ST MICHAEL HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 06/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19342 FLORIDA BLVD.
ALBANY LA
70711-0000
US

IV. Provider business mailing address

19342 FLORIDA BLVD
ALBANY LA
70711-4110
US

V. Phone/Fax

Practice location:
  • Phone: 225-243-7358
  • Fax: 225-673-3172
Mailing address:
  • Phone: 225-243-7358
  • Fax: 225-673-3172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number155
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number320
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number344
License Number StateLA

VIII. Authorized Official

Name: MRS. BONNIE MORALES
Title or Position: ADMINISTRATOR
Credential: ADMINISTRATOR/RN
Phone: 225-241-2420