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General NPI Number Information
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NPI Number | 1700883063
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Entity Type | Organization
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Legal Business Name | HOSPICE OF SHREVEPORT, INC.
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Dates
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Enumeration Date | 07/01/2005
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Last Update Date | 04/13/2010
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Provider Practice Location Address
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Address Line | 3829 GILBERT MADISON PARK
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City | SHREVEPORT
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State | LA
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Zip | 71104-5005
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Country | US
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Telephone | 318-865-7177
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Fax | 318-865-4077
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Provider Business Mailing Address
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Address Line | 3829 GILBERT DR MADISON PARK BUSINESS CENTER
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City | SHREVEPORT
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State | LA
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Zip | 71104-5005
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Country | US
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Telephone | 318-865-7177
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Fax | 318-865-4077
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. MARTHA C. MCDURMOND
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Credential | CHA, NFA
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Telephone | 318-865-7177
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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 | 263
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License Number State | LA
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