Provider Demographics
NPI:1508819251
Name:THE CARPENTER HOSPICE OF NORTHWEST LOUISIANA L.L.C.
Entity Type:Organization
Organization Name:THE CARPENTER HOSPICE OF NORTHWEST LOUISIANA L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-769-2449
Mailing Address - Street 1:10615 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-7230
Mailing Address - Country:US
Mailing Address - Phone:225-769-2449
Mailing Address - Fax:225-757-1104
Practice Address - Street 1:364 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SIBLEY
Practice Address - State:LA
Practice Address - Zip Code:71073-2985
Practice Address - Country:US
Practice Address - Phone:318-371-3673
Practice Address - Fax:318-371-3675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA129251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1580864Medicaid
LA191578Medicare ID - Type Unspecified