=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275738957
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CROSSROADS HOSPICE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2007
-----------------------------------------------------
Last Update Date | 09/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 702 FIRST STREET
-----------------------------------------------------
City | DELHI
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-878-2182
-----------------------------------------------------
Fax | 318-878-2185
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 206 705 BROADWAY ST.
-----------------------------------------------------
City | DELHI
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-878-2182
-----------------------------------------------------
Fax | 318-878-2185
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RN, DON, ADM
-----------------------------------------------------
Name | MS. MARY ELIZABETH WESTMORELAND
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 318-878-2182
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number | 345
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------