Healthcare Provider Details

I. General information

NPI: 1619294543
Provider Name (Legal Business Name): SACRED HEART HOSPICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 BAYOU TORTUE RD
BROUSSARD LA
70518-7506
US

IV. Provider business mailing address

620 BAYOU TORTUE RD
BROUSSARD LA
70518-7506
US

V. Phone/Fax

Practice location:
  • Phone: 337-837-6420
  • Fax: 337-837-6665
Mailing address:
  • Phone: 337-837-6420
  • Fax: 337-837-6665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: RANDY D. A. CHARLES
Title or Position: PRESIDENT
Credential:
Phone: 337-837-6420