Healthcare Provider Details

I. General information

NPI: 1114316080
Provider Name (Legal Business Name): LHCG LXV, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1226 LINN ST SUITE D
SIKESTON MO
63801-5200
US

IV. Provider business mailing address

PO BOX 51266
LAFAYETTE LA
70505-1266
US

V. Phone/Fax

Practice location:
  • Phone: 573-471-1438
  • Fax: 573-471-4804
Mailing address:
  • Phone: 337-233-1307
  • Fax: 337-233-5764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS GACHASSIN
Title or Position: SECRETARY
Credential:
Phone: 337-233-1307