1770129504 NPI number — COMPASSIONATE CARE HOSPICE OF LAKE AND SUMTER INC

Table of content: (NPI 1770129504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770129504 NPI number — COMPASSIONATE CARE HOSPICE OF LAKE AND SUMTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPASSIONATE CARE HOSPICE OF LAKE AND SUMTER INC
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:
PALLIATIVE CARE CONNECTIONS
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:
1770129504
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2024
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:
304 LAGRANDE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THE VILLAGES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32159-2388
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-415-0778
Provider Business Practice Location Address Fax Number:
352-404-7727
Provider Enumeration Date:
11/27/2019

Additional Information

Authorized Official

Authorized Official Last Name:
MIGLICCO
Authorized Official First Name:
TRAVIS
Authorized Official Middle Name:
Authorized Official Title or Position:
VP TAX
Authorized Official Telephone Number:
225-299-3803

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 109805600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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