MEDICARE: CONCERNED CARE HOSPICE 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	146A	LA

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	:	1932117645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCERNED CARE HOSPICE LLC

Provider Business Mailing Address
First Line	:	110 WISTERIA DR
Second Line	:
City	:	PASS CHRISTIAN
State	:	MS
Zip	:	39571-4728
Country	:	US
Telephone Number	:	985-892-3947
Fax Number	:	504-518-5749

Provider Business Practice Location Address
First Line	:	3621 RIDGELAKE DR STE 201
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70002-1739
Country	:	US
Telephone Number	:	504-210-1971
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JODY MARTIN
Credential	:
Telephone Number	:	985-892-3947

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	05/23/2024

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