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General NPI Number Information
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NPI Number | 1265792808
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Entity Type | Organization
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Legal Business Name | ST. LUKE MISSIONARY HOSPICE, LLC
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Dates
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Enumeration Date | 05/16/2012
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Last Update Date | 05/16/2012
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Provider Practice Location Address
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Address Line | 202 W MAIN AVENUE
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City | LUMBERTON
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State | MS
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Zip | 39455
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Country | US
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Telephone | 601-796-7993
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Fax | 866-533-5971
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Provider Business Mailing Address
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Address Line | 22 PARLANGE DRIVE
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City | DESTREHAN
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State | LA
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Zip | 70047
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Country | US
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Telephone | 504-201-5729
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DUANE A DUFRENE
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Credential | CPA
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Telephone | 504-201-5729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 202
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License Number State | MS
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