Provider Demographics
NPI:1902872450
Name:SOUTHEAST LOUISIANA HOSPICE
Entity Type:Organization
Organization Name:SOUTHEAST LOUISIANA HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAY
Authorized Official - Middle Name:D
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:985-735-5529
Mailing Address - Street 1:PO BOX 816
Mailing Address - Street 2:1406-B AVENUE F
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70429-0816
Mailing Address - Country:US
Mailing Address - Phone:985-735-5293
Mailing Address - Fax:985-732-9193
Practice Address - Street 1:1406B AVENUE F
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-4341
Practice Address - Country:US
Practice Address - Phone:985-735-5293
Practice Address - Fax:985-732-9193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA151251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1580767Medicaid
LA191597Medicare ID - Type UnspecifiedHOSPICE MEDICARE PROVIDER