Healthcare Provider Details

I. General information

NPI: 1275632762
Provider Name (Legal Business Name): CANON HOSPICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/24/2020
Certification Date: 07/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13702 COURSEY BLVD STE 6A
BATON ROUGE LA
70817-1370
US

IV. Provider business mailing address

13702 COURSEY BLVD STE 6A
BATON ROUGE LA
70817-1370
US

V. Phone/Fax

Practice location:
  • Phone: 225-926-1404
  • Fax: 225-926-1403
Mailing address:
  • Phone: 225-926-1404
  • Fax: 225-926-1403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number149
License Number StateLA

VIII. Authorized Official

Name: SHIVA K AKULA
Title or Position: OWNER
Credential: MD
Phone: 504-818-2723