MEDICARE: LAKESHORE HOSPICE ACQUISITION, 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	2203781977	LA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19-1588	OTHER	LA	MEDICARE PTAN

Other Identifiers

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

General Provider Information

NPI Number	:	1508833617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKESHORE HOSPICE ACQUISITION, LLC

Provider Business Mailing Address
First Line	:	15781 PROFESSIONAL PLZ
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70403-1452
Country	:	US
Telephone Number	:	985-549-1877
Fax Number	:	985-375-1192

Provider Business Practice Location Address
First Line	:	15781 PROFESSIONAL PLZ
Second Line	:
City	:	HAMMOND
State	:	LA
Zip	:	70403-1452
Country	:	US
Telephone Number	:	985-549-1877
Fax Number	:	985-375-1192

Authorized Official
Title or Position	:	MEMBER/ADMINISTRATOR
Name	:	MR. CHRIS JOSEPH LOPEZ
Credential	:
Telephone Number	:	985-549-1877

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	12/24/2014

Similar Medicare Providers

1043585854 — JESSICA BOSCH BORDELON APRN
Practice Location Address:

15799 PROFESSIONAL PLZ
HAMMOND, LA
70403-1452

Practice Phone: 985-419-0025
Practice Fax: 985-419-0035

1912904707 — MODERN HOME HEALTH, INC.
Practice Location Address:

15781 PROFESSIONAL PLZ
HAMMOND, LA
70403-1452

Practice Phone: 985-429-0210
Practice Fax: 985-429-2635

1972590164 — MR. FRANK PATRICK HENCHY III MD
Practice Location Address:

15709 PROFESSIONAL PLZ
HAMMOND, LA
70403-1452

Practice Phone: 985-542-9333
Practice Fax: 985-542-4988

1457335531 — MARY M DOBSON MD LLC
Practice Location Address:

15709 PROFESSIONAL PLZ
HAMMOND, LA
70403-1452

Practice Phone: 985-542-9333
Practice Fax: 985-542-4988

1558330191 — GENESIS HOSPICE, LLC
Practice Location Address:

15781 PROFESSIONAL PLZ
HAMMOND, LA
70403-1452

Practice Phone: 985-429-0210
Practice Fax: 877-293-6687

1073578233 — AHMAD MANOUCHEHRI MD APMC
Practice Location Address:

15799 PROFESSIONAL PLZ
HAMMOND, LA
70403-1452

Practice Phone: 985-345-5621
Practice Fax: 985-345-5622

Directions to “LAKESHORE HOSPICE ACQUISITION, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.