Provider Demographics
NPI:1295888188
Name:HOSPICE TLC, INC
Entity type:Organization
Organization Name:HOSPICE TLC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:F
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:318-435-9111
Mailing Address - Street 1:PO BOX 1547
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71295-1547
Mailing Address - Country:US
Mailing Address - Phone:318-435-9111
Mailing Address - Fax:
Practice Address - Street 1:2401 LOOP RD
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-3403
Practice Address - Country:US
Practice Address - Phone:318-435-9111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA177251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1584177Medicaid
LA31197OtherBCBS OF LA PROVIDER NUMBE
LA1584177Medicaid