Provider Demographics
NPI:1215928551
Name:FAITH FOUNDATION HOSPICE
Entity type:Organization
Organization Name:FAITH FOUNDATION HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BROSSETT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:318-443-5545
Mailing Address - Street 1:PO BOX 11757
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315-1757
Mailing Address - Country:US
Mailing Address - Phone:318-443-5545
Mailing Address - Fax:318-564-6534
Practice Address - Street 1:3503 PARLIAMENT CT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3135
Practice Address - Country:US
Practice Address - Phone:318-443-5545
Practice Address - Fax:318-561-6534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1580635Medicaid
LA105OtherLOUISIANA LICENSE
LA191547Medicare ID - Type UnspecifiedPROVIDER NUMBER