MEDICARE: SOUTHERN GRACE HOSPICE SOUTH 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

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	:	1598864084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN GRACE HOSPICE SOUTH LLC

Provider Business Mailing Address
First Line	:	9256 INTERLINE AVENUE
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-1907
Country	:	US
Telephone Number	:	225-218-8009
Fax Number	:	225-237-1170

Provider Business Practice Location Address
First Line	:	3621 RIDGELAKE DRIVE
Second Line	:	SUITE 305
City	:	METAIRIE
State	:	LA
Zip	:	70002-1739
Country	:	US
Telephone Number	:	504-274-1942
Fax Number	:	504-274-1943

Authorized Official
Title or Position	:	ACCOUNTING MANAGER
Name	:	DIANNE TROXCLAIR
Credential	:
Telephone Number	:	225-218-8009

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	09/02/2025

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