1033112685 NPI number — COMPASSIONATE CARE HOSPICE OF MARLTON, LLC

Table of content: (NPI 1033112685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033112685 NPI number — COMPASSIONATE CARE HOSPICE OF MARLTON, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPASSIONATE CARE HOSPICE OF MARLTON, 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:
Provider Other Organization Name Type Code:
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:
1033112685
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2021
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:
261 CONNECTICUT DR
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08016-4177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-267-1178
Provider Business Practice Location Address Fax Number:
609-267-3499
Provider Enumeration Date:
05/27/2005

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 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6538703 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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