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General NPI Number Information
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NPI Number | 1902303647
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Entity Type | Organization
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Legal Business Name | GRACE HOSPICE AND PALLIATIVE CARE, LLC
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Dates
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Enumeration Date | 04/10/2018
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 217 RUE LOUIS XIV STE 100
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City | LAFAYETTE
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State | LA
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Zip | 70508-5778
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Country | US
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Telephone | 337-948-9004
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Fax |
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Provider Business Mailing Address
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Address Line | 217 RUE LOUIS XIV STE 100
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City | LAFAYETTE
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State | LA
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Zip | 70508-5778
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TIMOTHY BERGERON
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Credential |
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Telephone | 337-948-9004
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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 | 2203782734
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License Number State | LA
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