Provider Demographics
NPI:1457566200
Name:HEART OF HOSPICE OF LAKE CHARLES LLC
Entity Type:Organization
Organization Name:HEART OF HOSPICE OF LAKE CHARLES LLC
Other - Org Name:HEART OF HOSPICE
Other - Org Type:Other Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-251-9781
Mailing Address - Street 1:750 BAYOU PINES EAST DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-7184
Mailing Address - Country:US
Mailing Address - Phone:337-855-5154
Mailing Address - Fax:337-433-9221
Practice Address - Street 1:750 BAYOU PINES EAST DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7184
Practice Address - Country:US
Practice Address - Phone:337-855-5154
Practice Address - Fax:337-433-9221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA321251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA191642Medicare Oscar/Certification