Healthcare Provider Details

I. General information

NPI: 1386834877
Provider Name (Legal Business Name): PREMIER HOSPICE OF MONROE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 LOUISVILLE AVE STE 128
MONROE LA
71201-6027
US

IV. Provider business mailing address

1523 TEXAS AVE
BASTROP LA
71220-4043
US

V. Phone/Fax

Practice location:
  • Phone: 318-388-0555
  • Fax: 318-388-0510
Mailing address:
  • Phone: 318-281-0000
  • Fax: 318-281-2753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHARLES GOODWIN GLADNEY JR.
Title or Position: MANAGING PARTNER
Credential:
Phone: 318-281-0000