Provider Demographics
NPI:1508224718
Name:LA PORTE HOME CARE SERVICES, LLC
Entity Type:Organization
Organization Name:LA PORTE HOME CARE SERVICES, LLC
Other - Org Name:HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR DIRECTOR/AUTHORIZED OFFICIAL
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:901 S WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-5672
Mailing Address - Country:US
Mailing Address - Phone:219-871-8100
Mailing Address - Fax:
Practice Address - Street 1:901 S WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-5672
Practice Address - Country:US
Practice Address - Phone:219-871-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN151506Medicare Oscar/Certification