Provider Demographics
NPI:1508075912
Name:LHCG-XII, LLC
Entity Type:Organization
Organization Name:LHCG-XII, LLC
Other - Org Name:IBERIA EXTENDED CARE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:INDEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-233-1307
Mailing Address - Street 1:420 W PINHOOK RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2131
Mailing Address - Country:US
Mailing Address - Phone:337-233-1307
Mailing Address - Fax:337-233-5764
Practice Address - Street 1:2315 E MAIN ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4031
Practice Address - Country:US
Practice Address - Phone:337-369-1100
Practice Address - Fax:337-369-1122
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LHCG-XII, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-22
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA607-A282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1700665Medicaid
LA1700665Medicaid