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General NPI Number Information
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NPI Number | 1053379214
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Entity Type | Organization
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Legal Business Name | ADVENTA HOSPICE, LLC
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | 1420 DUTCH VALLEY DR SUITE C
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City | KNOXVILLE
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State | TN
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Zip | 37918-1424
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Country | US
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Telephone | 865-689-7123
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Fax | 865-689-8445
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Provider Business Mailing Address
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Address Line | 3854 AMERICAN WAY SUITE A
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City | BATON ROUGE
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State | LA
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Zip | 70816-4013
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Country | US
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Telephone | 225-292-2031
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Fax | 225-295-9678
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PAUL KUSSEROW
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Credential |
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Telephone | 225-292-2031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 344
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License Number State | TN
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