MEDICARE: LHCG CXVII, 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

General Provider Information

NPI Number	:	1518482181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LHCG CXVII, 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	:	337-233-5764

Provider Business Practice Location Address
First Line	:	5253 PRUE RD BLDG 1
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1758
Country	:	US
Telephone Number	:	210-785-5255
Fax Number	:	210-785-5389

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOSHUA L PROFFITT
Credential	:
Telephone Number	:	337-233-1307

Provider Enumeration Date	:	08/04/2017
Last Update Date	:	07/10/2024

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