Premier Hospice of Mangham, LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

TBD Issued in LA

Legal business name

PREMIER HOSPICE OF MANGHAM, LLC

Practice address

104-2 West Bayou
Farmerville, LA 71241

Phone

(318) 281-0000

Fax

(318) 281-2753

NPI assigned

Jul 30, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charles Goodwin Gladney Jr.

Title

Managing Partner

Phone

(318) 281-0000

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185753600000",
    "number": "1093905762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1523 TEXAS AVE",
            "city": "BASTROP",
            "state": "LA",
            "postal_code": "712204043",
            "telephone_number": "318-281-0000",
            "fax_number": "318-281-2753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104-2 WEST BAYOU",
            "city": "FARMERVILLE",
            "state": "LA",
            "postal_code": "71241",
            "telephone_number": "318-281-0000",
            "fax_number": "318-281-2753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER HOSPICE OF MANGHAM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-30",
        "last_updated": "2007-07-30",
        "status": "A",
        "authorized_official_last_name": "GLADNEY",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "GOODWIN",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "318-281-0000",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "LA",
            "license": "TBD",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daisy Elizabeth Peterson, PA-C
• Jodi Alline Pilgreen, B.S. PHARM
• Marquita Chiffon Pitts
• Tracy Porto, PT
• Retha Powell
• Jennifer Lynn Prichard, FNP-C
• Sharon Purifoy
• Ryan Joseph Rachal, DDS
• Lauren Hearn Ratcliff, MS CCC-CLP
• Derek R. Reid, LCSW

• Community Based Hospice Care Agency in Farmerville, LA
• Providers in Farmerville, LA by specialty
• Community Based Hospice Care Agency in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.