Healthcare Provider Details

I. General information

NPI: 1265792808
Provider Name (Legal Business Name): ST. LUKE MISSIONARY HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 W MAIN AVENUE
LUMBERTON MS
39455
US

IV. Provider business mailing address

22 PARLANGE DRIVE
DESTREHAN LA
70047
US

V. Phone/Fax

Practice location:
  • Phone: 601-796-7993
  • Fax: 866-533-5971
Mailing address:
  • Phone: 504-201-5729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number202
License Number StateMS

VIII. Authorized Official

Name: MR. DUANE A DUFRENE
Title or Position: OWNER
Credential: CPA
Phone: 504-201-5729