Provider Demographics
NPI:1114200870
Name:REGIONAL HOSPICE CARE GROUP NWLA, LLC
Entity Type:Organization
Organization Name:REGIONAL HOSPICE CARE GROUP NWLA, LLC
Other - Org Name:BRISTOL HOSPICE - NW LOUISIANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:E
Authorized Official - Last Name:MAURICIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-325-0175
Mailing Address - Street 1:REGIONAL HOSPICE CARE GROUP, NWLA 1634 HIGHWAY 531
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-6530
Mailing Address - Country:US
Mailing Address - Phone:318-382-9396
Mailing Address - Fax:318-377-2120
Practice Address - Street 1:1634 HIGHWAY 531
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-6530
Practice Address - Country:US
Practice Address - Phone:318-382-9396
Practice Address - Fax:318-377-2120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1584169Medicaid