Healthcare Provider Details

I. General information

NPI: 1093823890
Provider Name (Legal Business Name): HARBOR HOSPICE OF LAKE CHARLES, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5210 LAKE ST
LAKE CHARLES LA
70605-6574
US

IV. Provider business mailing address

3406 COLLEGE ST SUITE 200
BEAUMONT TX
77701-4612
US

V. Phone/Fax

Practice location:
  • Phone: 337-562-8620
  • Fax: 337-562-8621
Mailing address:
  • Phone: 409-813-2332
  • Fax: 409-232-0573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number185
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number19-1625
License Number StateLA

VIII. Authorized Official

Name: KAREN CARTER
Title or Position: EXEC ADMIN ASST
Credential:
Phone: 409-730-2046