Provider Demographics
NPI:1255898763
Name:SAINT MARK HOSPICE AND PALLIATIVE CARE LLC
Entity type:Organization
Organization Name:SAINT MARK HOSPICE AND PALLIATIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:318-780-2482
Mailing Address - Street 1:657 JORDAN ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4748
Mailing Address - Country:US
Mailing Address - Phone:318-780-1401
Mailing Address - Fax:318-626-7064
Practice Address - Street 1:SAINT MARK HOSPICE AND PALLIATIVE CARE LLC
Practice Address - Street 2:298 ARMY RD
Practice Address - City:COUSHATTA
Practice Address - State:LA
Practice Address - Zip Code:71019
Practice Address - Country:US
Practice Address - Phone:318-780-1401
Practice Address - Fax:318-626-7064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based