=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770998528
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LHCG LXIII, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2014
-----------------------------------------------------
Last Update Date | 09/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6100 219TH ST SW STE 440
-----------------------------------------------------
City | MOUNTLAKE TERRACE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98043-2222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-364-1484
-----------------------------------------------------
Fax | 206-364-1286
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 51266
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70505-1266
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-233-1307
-----------------------------------------------------
Fax | 337-233-5764
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOSHUA L PROFFITT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 337-233-1307
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------