Provider Demographics
NPI:1023215639
Name:ST. JOSEPH HOSPICE OF MONROE, L.L.C.
Entity Type:Organization
Organization Name:ST. JOSEPH HOSPICE OF MONROE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-769-2449
Mailing Address - Street 1:10615 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-7230
Mailing Address - Country:US
Mailing Address - Phone:225-769-2449
Mailing Address - Fax:225-757-1104
Practice Address - Street 1:1890 HUDSON CIR
Practice Address - Street 2:SUITE 3
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3538
Practice Address - Country:US
Practice Address - Phone:318-372-6831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA191620Medicare Oscar/Certification