Provider Demographics
NPI:1982704219
Name:ST MICHAEL HOSPICE, LLC
Entity Type:Organization
Organization Name:ST MICHAEL HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR/RN
Authorized Official - Phone:225-241-2420
Mailing Address - Street 1:19342 FLORIDA BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:LA
Mailing Address - Zip Code:70711-4110
Mailing Address - Country:US
Mailing Address - Phone:225-243-7358
Mailing Address - Fax:225-673-3172
Practice Address - Street 1:19342 FLORIDA BLVD.
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:LA
Practice Address - Zip Code:70711-0000
Practice Address - Country:US
Practice Address - Phone:225-243-7358
Practice Address - Fax:225-673-3172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA155251G00000X
LA320251G00000X
LA344251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1583910Medicaid
LA1583910Medicaid
LA191600Medicare Oscar/Certification