Healthcare Provider Details

I. General information

NPI: 1033313200
Provider Name (Legal Business Name): HARBOR HOSPICE OF OAKDALE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 N 16TH ST
OAKDALE LA
71463-2211
US

IV. Provider business mailing address

3406 COLLEGE ST SUITE 200
BEAUMONT TX
77701-4612
US

V. Phone/Fax

Practice location:
  • Phone: 318-335-5029
  • Fax: 318-335-5066
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 NumberPENDING
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number19-1656
License Number StateLA

VIII. Authorized Official

Name: MR. BRAD THIBODAUX
Title or Position: CHIEF DATA OFFICER
Credential:
Phone: 409-813-2332