1518128990 NPI number — COMPASSIONATE CARE HOSPICE OF SOUTHEASTERN TX, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518128990 NPI number — COMPASSIONATE CARE HOSPICE OF SOUTHEASTERN TX, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPASSIONATE CARE HOSPICE OF SOUTHEASTERN TX, 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:
AMEDISYS 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:
1518128990
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3854 AMERICAN WAY STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70816-4897
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-292-2031
Provider Business Mailing Address Fax Number:
225-295-9678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
903C HILLCREST DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONROE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77301-1106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-924-8000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GOFF
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
U.
Authorized Official Title or Position:
DELEGATED OFFICIAL
Authorized Official Telephone Number:
225-299-3701

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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