1457429813 NPI number — PASSAGES HOSPICE NORTH - NORTHEAST, LLC.

Table of content: (NPI 1457429813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457429813 NPI number — PASSAGES HOSPICE NORTH - NORTHEAST, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PASSAGES HOSPICE NORTH - NORTHEAST, LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PASSAGES HOSPICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457429813
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 AURBURN AVENUE
Provider Second Line Business Mailing Address:
STE. 6
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71201-3028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-387-1115
Provider Business Mailing Address Fax Number:
866-981-5917

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 AURBURN AVE.
Provider Second Line Business Practice Location Address:
STE. 6
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71201-7120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-387-1115
Provider Business Practice Location Address Fax Number:
866-981-5917
Provider Enumeration Date:
12/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DAY
Authorized Official First Name:
CARLIE
Authorized Official Middle Name:
STEVENSON
Authorized Official Title or Position:
VICE PRESIDENT OF HOSPICE OPS
Authorized Official Telephone Number:
318-371-1140

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  305 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 315D00000X , with the licence number: 83 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1580465 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".