Healthcare Provider Details

I. General information

NPI: 1154951283
Provider Name (Legal Business Name): PALLIATIVE CARE AT HEART, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BAYOU PL
ALEXANDRIA LA
71303-5828
US

IV. Provider business mailing address

134 COLUMBUS ST
CHARLESTON SC
29403-4809
US

V. Phone/Fax

Practice location:
  • Phone: 318-880-0223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JIM PETRUS
Title or Position: CFO
Credential:
Phone: 843-410-6691