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General NPI Number Information
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NPI Number | 1508833617
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Entity Type | Organization
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Legal Business Name | LAKESHORE HOSPICE ACQUISITION, LLC
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Dates
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Enumeration Date | 03/07/2006
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Last Update Date | 12/24/2014
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Provider Practice Location Address
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Address Line | 15781 PROFESSIONAL PLZ
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City | HAMMOND
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State | LA
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Zip | 70403-1452
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Country | US
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Telephone | 985-549-1877
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Fax | 985-375-1192
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Provider Business Mailing Address
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Address Line | 15781 PROFESSIONAL PLZ
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City | HAMMOND
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State | LA
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Zip | 70403-1452
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Country | US
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Telephone | 985-549-1877
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Fax | 985-375-1192
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Authorized Official
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Title or Position | MEMBER/ADMINISTRATOR
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Name | MR. CHRIS JOSEPH LOPEZ
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Credential |
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Telephone | 985-549-1877
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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 | 2203781977
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License Number State | LA
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