MEDICARE: LHCG CCXV, 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1508576851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LHCG CCXV, LLC

Provider Business Mailing Address
First Line	:	PO BOX 51266
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70505-1266
Country	:	US
Telephone Number	:	337-233-1307
Fax Number	:	337-443-4154

Provider Business Practice Location Address
First Line	:	4 BRIGHTON RD STE 404
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07012-1646
Country	:	US
Telephone Number	:	973-685-5233
Fax Number	:	973-685-5299

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT
Name	:	NICHOLAS GACHASSIN III
Credential	:
Telephone Number	:	337-233-1307

Provider Enumeration Date	:	11/28/2022
Last Update Date	:	11/28/2022

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