Provider Demographics
NPI:1730797739
Name:PRIME STAR HOSPICE NWLA
Entity type:Organization
Organization Name:PRIME STAR HOSPICE NWLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASTLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN-HCS-C
Authorized Official - Phone:318-259-1410
Mailing Address - Street 1:1527 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-3694
Mailing Address - Country:US
Mailing Address - Phone:318-259-1410
Mailing Address - Fax:318-532-6088
Practice Address - Street 1:2434 MANNINGS ST STE 2
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:LA
Practice Address - Zip Code:71068-2401
Practice Address - Country:US
Practice Address - Phone:318-259-1410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-16
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based