Provider Demographics
NPI:1952731580
Name:J. DONALD PERSICH
Entity Type:Organization
Organization Name:J. DONALD PERSICH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:CHPLN, CHA
Authorized Official - Phone:504-729-6920
Mailing Address - Street 1:4609 GARY MIKEL AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-1459
Mailing Address - Country:US
Mailing Address - Phone:504-887-5010
Mailing Address - Fax:504-734-3509
Practice Address - Street 1:1221 S. CLEARVIEW PKWY, FOURTH FLOOR
Practice Address - Street 2:CANON HOSPICE
Practice Address - City:JEFFERSON
Practice Address - State:LA
Practice Address - Zip Code:70121
Practice Address - Country:US
Practice Address - Phone:504-818-2723
Practice Address - Fax:504-734-3509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA006826OtherMEDICAL LICENSE NUMBER STATE OF LOUISIANA