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St. Joseph Hospice and Palliative Care Northshore LLC

Organization Active NPI Community Based Hospice Care Agency · Covington, LA

NPI 1710051669 · NPPES record last updated Feb 24, 2023

Key facts

NPI
1710051669
Entity type
Organization (NPI type 2)
Primary specialty
Community Based Hospice Care Agency 251G00000X
License
202 (LA)
Legal business name
ST. JOSEPH HOSPICE AND PALLIATIVE CARE NORTHSHORE LLC
Practice address
409 W 21St Ave
Covington, LA 70433-3011
Phone
(985) 892-6955
Fax
(985) 302-3754
NPI assigned
Nov 20, 2006
Organization subpart
No

Authorized official

Name
Patrick Mitchell
Title
Managing Member
Phone
(225) 769-2449

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 35

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 35

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

Medicare Care Compare: Hospice

Listed as
St Joseph Hospice and Palliative Care Northshore, CCN 191635
Ownership
For-Profit
Certified
Mar 19, 2007
Medicare certification status
Active (Provider of Services file)

Source: Medicare Care Compare.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D1064405St Joseph Hospice and Palliative Care-Northshore
409 W 21St Avenue, Covington, LA 70433		Certificate of waiverOct 26, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in LA

Hospice certification: CCN 191635

Legal name
ST. JOSEPH HOSPICE AND PALLIATIVE CARE NORTHSHORE, LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Mar 19, 2007
Last certification
Oct 5, 2020
Ownership / control type
Proprietary - Corporation
Organization structure
LLC · Proprietary
Enrollment address
409 W 21St Ave
Ste a
Covington, LA 70433-3011

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Shahed M Jameel
Individual 		Contracted Managing Employee
Hospice Medical Director		 Feb 17, 2021
Melissa Lynn Taylor
Individual 		W-2 Managing Employee
Ad;		 Mar 10, 2026
Patrick Thomas Mitchell
Individual 		Operational/Managerial Control
Manager		 Oct 19, 2006
Other May 1, 2019 1%
PCM Hospice Enterprises LLC
Organization · Baton Rouge, LA
Created for acquisition, LLC 		5% Or Greater Direct Ownership Interest May 1, 2019 100%
Kelly Mitchell
Individual 		Other
Co-Managing Trustee		 Dec 31, 2022
PCM Intermediate Holdings LLC
Organization · Baton Rouge, LA
LLC, Holding company 		5% Or Greater Indirect Ownership Interest Jul 18, 2025 100%
PTM 2018 Family Trust
Organization · Baton Rouge, LA
Created for acquisition 		5% Or Greater Indirect Ownership Interest Dec 31, 2022 99%
Emily Holleman
Individual 		Other
Co-Managing Trustee		 Dec 31, 2022
PCM Holdings I, Inc.
Organization · Baton Rouge, LA
Corporation, Holding company 		5% Or Greater Indirect Ownership Interest Jul 18, 2025 100%

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20070126000280 LA Part a Provider - Hospice 9739180258 Practice locations: Covington, LA

National Provider Directory

Locations

409 W 21st Ave
Covington, LA 70433
Phone (985) 892-6955

1121 S Tyler St
Unit 5
Covington, LA 70433
Phone (985) 626-9980

409 W 21st Ave
Ste A
Covington, LA 70433
Phone (985) 892-6955

1400 Gause Blvd
Slidell, LA 70458

1400 Gause Blvd
Ste 200
Slidell, LA 70458
Phone (985) 257-4090

722 W Canal St
Picayune, MS 39466
Phone (601) 799-2488

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 202 LA Yes

Addresses

Primary practice location

409 W 21St Ave
Covington, LA 70433-3011

Mailing address

10615 Jefferson Hwy
Baton Rouge, LA 70809-7230
Phone (225) 769-2449

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 24, 2023.

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677196800000",
    "number": "1710051669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10615 JEFFERSON HWY",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708097230",
            "telephone_number": "225-769-2449",
            "fax_number": "225-757-1104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 W 21ST AVE",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704333011",
            "telephone_number": "985-892-6955",
            "fax_number": "985-302-3754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOSEPH HOSPICE AND PALLIATIVE CARE NORTHSHORE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2023-02-24",
        "certification_date": "2023-02-24",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "225-769-2449"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "LA",
            "license": "202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Covington, LA

All providers in Covington, LA · Community Based Hospice Care Agency in Louisiana

Sources for this page

Verify at the official NPI Registry.