Provider Demographics
NPI:1265792808
Name:ST. LUKE MISSIONARY HOSPICE, LLC
Entity type:Organization
Organization Name:ST. LUKE MISSIONARY HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUFRENE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:504-201-5729
Mailing Address - Street 1:22 PARLANGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:DESTREHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70047
Mailing Address - Country:US
Mailing Address - Phone:504-201-5729
Mailing Address - Fax:
Practice Address - Street 1:202 W MAIN AVENUE
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:MS
Practice Address - Zip Code:39455
Practice Address - Country:US
Practice Address - Phone:601-796-7993
Practice Address - Fax:866-533-5971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS202261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service