MEDICARE: LHCG CCVIII, 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	:	1790458776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LHCG CCVIII, 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	:	6150 PARKLAND BLVD STE 250
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-6147
Country	:	US
Telephone Number	:	440-373-1113
Fax Number	:	440-373-1115

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

Provider Enumeration Date	:	07/27/2021
Last Update Date	:	04/11/2025

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