Provider Demographics
NPI:1134490238
Name:HOSPICE 2012, LLC
Entity Type:Organization
Organization Name:HOSPICE 2012, LLC
Other - Org Name:BRIDGEWAY HEALTHCARE & HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:225-753-1495
Mailing Address - Street 1:4333 AMERICAN WAY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-0402
Mailing Address - Country:US
Mailing Address - Phone:225-753-1495
Mailing Address - Fax:225-753-1301
Practice Address - Street 1:4333 AMERICAN WAY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-0402
Practice Address - Country:US
Practice Address - Phone:225-753-1495
Practice Address - Fax:225-753-1301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA306251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based