Provider Demographics
NPI:1457429813
Name:PASSAGES HOSPICE NORTH - NORTHEAST, LLC.
Entity Type:Organization
Organization Name:PASSAGES HOSPICE NORTH - NORTHEAST, LLC.
Other - Org Name:PASSAGES HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF HOSPICE OPS
Authorized Official - Prefix:
Authorized Official - First Name:CARLIE
Authorized Official - Middle Name:STEVENSON
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-371-1140
Mailing Address - Street 1:1900 AURBURN AVENUE
Mailing Address - Street 2:STE. 6
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3028
Mailing Address - Country:US
Mailing Address - Phone:318-387-1115
Mailing Address - Fax:866-981-5917
Practice Address - Street 1:1900 AURBURN AVE.
Practice Address - Street 2:STE. 6
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7120
Practice Address - Country:US
Practice Address - Phone:318-387-1115
Practice Address - Fax:866-981-5917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA305251G00000X
251G00000X
LA83315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1580465Medicaid
LA191541Medicare Oscar/Certification