MEDICARE: ANGEL CARE HOSPICE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	75	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073739975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGEL CARE HOSPICE, INC.

Provider Business Mailing Address
First Line	:	1406 NE EVANGELINE TRWY
Second Line	:	SUITE 100
City	:	LAFAYETTE
State	:	LA
Zip	:	70501-2830
Country	:	US
Telephone Number	:	337-534-8242
Fax Number	:	337-534-8243

Provider Business Practice Location Address
First Line	:	1406 NE EVANGELINE TRWY
Second Line	:	SUITE 100
City	:	LAFAYETTE
State	:	LA
Zip	:	70501-2830
Country	:	US
Telephone Number	:	337-534-8242
Fax Number	:	337-534-8243

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. KRISTAL GLOVER
Credential	:	RN
Telephone Number	:	337-534-8242

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	11/21/2016

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