Provider Demographics
NPI:1063470847
Name:LIFEPATH HOSPICE CARE SERVICES, LLC
Entity Type:Organization
Organization Name:LIFEPATH HOSPICE CARE SERVICES, LLC
Other - Org Name:LIFEPATH HOSPICE CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-709-1408
Mailing Address - Street 1:1500 N MARKET ST
Mailing Address - Street 2:SUITE B 108
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-6537
Mailing Address - Country:US
Mailing Address - Phone:318-222-5711
Mailing Address - Fax:318-222-5715
Practice Address - Street 1:1500 N MARKET ST
Practice Address - Street 2:SUITE B 108
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-6537
Practice Address - Country:US
Practice Address - Phone:318-222-5711
Practice Address - Fax:318-222-5715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA125251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1580775Medicaid
LA19-1574Medicare ID - Type UnspecifiedPROVIDER NUMBER