MEDICARE: LAKESIDE HOSPICE, LLC

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	173	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	:	1073841417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKESIDE HOSPICE, LLC

Provider Business Mailing Address
First Line	:	8150 N CENTRAL EXPY STE 1800
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-1883
Country	:	US
Telephone Number	:	469-839-3777
Fax Number	:	469-983-2083

Provider Business Practice Location Address
First Line	:	42268 VETERANS AVE STE A
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70403-1423
Country	:	US
Telephone Number	:	504-456-6011
Fax Number	:	504-456-6964

Authorized Official
Title or Position	:	LICENSING MANAGER
Name	:	ANGIE MARTIN
Credential	:
Telephone Number	:	903-787-7609

Provider Enumeration Date	:	11/23/2009
Last Update Date	:	03/27/2023

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Directions to “LAKESIDE HOSPICE, LLC ” Practice Location

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