Professional Hospice Care, L.L.C.
Organization Active NPI Community Based Hospice Care Agency · Ruston, LA
NPI 1649205261 · NPPES record last updated Jul 13, 2022
Key facts
- NPI
- 1649205261
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- License
- 156 (LA)
- Legal business name
- PROFESSIONAL HOSPICE CARE, L.L.C.
- Practice address
- 1229 Farmerville Hwy
Ruston, LA 71270-3513 - Phone
- (318) 232-1107
- Fax
- (318) 232-1108
- NPI assigned
- Jul 12, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Rock M Bordelon
- Title
- Owner
- Phone
- (318) 226-8202
Owners & managing parties with NPI records 1
-
David Juston Colvin, M.D.
Facilities with the same owner 12
Practitioners 34
-
Whitney Nicole Allen, LMSW
-
Laroya Sherrell Dickens, M.S.
-
Fred Ellis, MA
-
Traja Golston, CSW
-
Ashley Kober, LPC
-
Brittney Latoya Moore, MSW. BSW. CSW, MHP
Affiliated clinicians 2
-
Sedo Tamakloe, MD
Medicare Care Compare: Hospice
- Listed as
- Allegiance Hospice & Palliative Care
- Ownership
- For-Profit
- Certified
- Mar 9, 2005
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Hospice certification: CCN 191603
- Legal name
- PROFESSIONAL HOSPICE CARE, L.L.C.
- Doing business as
- ALLEGIANCE HOSPICE AND PALLIATIVE CARE
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Mar 9, 2005
- Last certification
- Jul 13, 2022
- Ownership / control type
- Proprietary - Other
- Organization structure
- LLC · Proprietary
- Incorporated
- Jul 8, 2004 in LA
- Enrollment address
- 1229 Farmerville Hwy
Ruston, LA 71270-3513
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| Rock Bordelon |
5% Or Greater Indirect Ownership Interest | Dec 31, 2021 | 95% |
| Corporate Officer | Dec 31, 2021 | ||
| Corporate Director | Dec 31, 2021 | ||
| Allegiance Healthcare of Louisiana, LLC |
5% Or Greater Indirect Ownership Interest | Jan 31, 2022 | 95% |
| David Colvin |
5% Or Greater Indirect Ownership Interest | Apr 5, 2022 | 5% |
| Brandon Melancon |
Corporate Officer |
Aug 8, 2022 | |
| Operational/Managerial Control |
Aug 8, 2022 | ||
| Joseph Monsour |
Corporate Director | Dec 31, 2021 | |
| Operational/Managerial Control | Dec 31, 2021 | ||
| Allegiance Hospice Care of Northeast Louisiana LLC |
5% Or Greater Direct Ownership Interest | Dec 31, 2021 | 100% |
| Allegiance Home Health LLC |
Operational/Managerial Control | Dec 31, 2021 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050413000353 | LA | Part a Provider - Hospice | 5698712453 | Practice locations: Ruston, LA |
National Provider Directory
Locations
118 Monticello Ave
Ste A
Ruston, LA 71270
Phone (318) 232-1107
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | 156 | LA | Yes |
Addresses
Primary practice location
1229 Farmerville Hwy
Ruston, LA 71270-3513
Mailing address
1229 Farmerville Hwy
Ruston, LA 71270-3513
Phone (318) 232-1107
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1583936 | Medicaid | LA |
Other names
- Allegiance Hospice Care of Northeast Louisiana
- North Central Louisiana Hospice Care, L.L.C.
Other providers in Ruston, LA
- Tyra Rene Price
- Prime Care Network of Monroe, LLC
- Samantha Taylor Primm
- Princeton Place - Ruston, LP
- Larry D. Proctor
- Jacques Prudhomme
- Lydia Prudhomme
- Rhonda Renee Pruitt
- Sherry Pruitt
- Ellie Puckett
All providers in Ruston, LA · Community Based Hospice Care Agency in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.