Healthcare Provider Details

I. General information

NPI: 1255898763
Provider Name (Legal Business Name): SAINT MARK HOSPICE AND PALLIATIVE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2019
Last Update Date: 02/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAINT MARK HOSPICE AND PALLIATIVE CARE LLC 298 ARMY RD
COUSHATTA LA
71019
US

IV. Provider business mailing address

657 JORDAN ST
SHREVEPORT LA
71101-4748
US

V. Phone/Fax

Practice location:
  • Phone: 318-780-1401
  • Fax: 318-626-7064
Mailing address:
  • Phone: 318-780-1401
  • Fax: 318-626-7064

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: MR. RYAN SCOTT COX
Title or Position: ADMINISTRATOR
Credential: LMSW
Phone: 318-780-2482