Healthcare Provider Details

I. General information

NPI: 1457566200
Provider Name (Legal Business Name): HEART OF HOSPICE OF LAKE CHARLES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 BAYOU PINES EAST DR SUITE A
LAKE CHARLES LA
70601-7184
US

IV. Provider business mailing address

750 BAYOU PINES EAST DR SUITE A
LAKE CHARLES LA
70601-7184
US

V. Phone/Fax

Practice location:
  • Phone: 337-855-5154
  • Fax: 337-433-9221
Mailing address:
  • Phone: 337-855-5154
  • Fax: 337-433-9221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number321
License Number StateLA

VIII. Authorized Official

Name: MR. JOHN MENDELL
Title or Position: MEMBER
Credential:
Phone: 337-251-9781