Provider Demographics
NPI:1881805059
Name:CANON HOSPICE-NORTH SHORE, LLC
Entity type:Organization
Organization Name:CANON HOSPICE-NORTH SHORE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIVA
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:AKULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-669-3825
Mailing Address - Street 1:PO BOX 850715
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70185-0715
Mailing Address - Country:US
Mailing Address - Phone:504-669-3825
Mailing Address - Fax:504-899-2377
Practice Address - Street 1:4045A DESOTO ST
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-1850
Practice Address - Country:US
Practice Address - Phone:504-669-3825
Practice Address - Fax:504-899-2377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based