Provider Demographics
NPI:1730707506
Name:GRACE PALLIATIVE CARE LLC
Entity type:Organization
Organization Name:GRACE PALLIATIVE CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-366-2293
Mailing Address - Street 1:217 RUE LOUIS XIV STE 100
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5778
Mailing Address - Country:US
Mailing Address - Phone:337-366-2293
Mailing Address - Fax:337-948-9200
Practice Address - Street 1:217 RUE LOUIS XIV STE 100
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5778
Practice Address - Country:US
Practice Address - Phone:337-366-2293
Practice Address - Fax:337-948-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-08
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center