Provider Demographics
NPI:1891798302
Name:HOSPICE OF SOUTH LOUISIANA, LLC
Entity Type:Organization
Organization Name:HOSPICE OF SOUTH LOUISIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-626-3281
Mailing Address - Street 1:PO BOX 650
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70470-0650
Mailing Address - Country:US
Mailing Address - Phone:985-626-3281
Mailing Address - Fax:985-626-8773
Practice Address - Street 1:6500 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2267
Practice Address - Country:US
Practice Address - Phone:985-868-3095
Practice Address - Fax:985-868-3910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-30
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA102251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1580694Medicaid
LA19-1510Medicare ID - Type UnspecifiedHOSPICE