=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043159098
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHERN GRACE HOSPICE SOUTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2026
-----------------------------------------------------
Last Update Date | 03/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3621 RIDGELAKE DR STE 305
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70002-1739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-274-1942
-----------------------------------------------------
Fax | 504-274-1943
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9256 INTERLINE AVE
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70809-1907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-274-1942
-----------------------------------------------------
Fax | 504-274-1943
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACCOUNTING MANAGER
-----------------------------------------------------
Name | MRS. DIANNE TROXCLAIR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 225-218-8009
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------