Healthcare Provider Details

I. General information

NPI: 1710051669
Provider Name (Legal Business Name): ST. JOSEPH HOSPICE AND PALLIATIVE CARE NORTHSHORE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 W 21ST AVE
COVINGTON LA
70433-3011
US

IV. Provider business mailing address

10615 JEFFERSON HWY
BATON ROUGE LA
70809-7230
US

V. Phone/Fax

Practice location:
  • Phone: 985-892-6955
  • Fax: 985-302-3754
Mailing address:
  • Phone: 225-769-2449
  • Fax: 225-757-1104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number202
License Number StateLA

VIII. Authorized Official

Name: PATRICK MITCHELL
Title or Position: MANAGING MEMBER
Credential:
Phone: 225-769-2449