NPIMap

Organization Active NPI

Premier Hospice, LLC

  • Community Based Hospice Care Agency
  • Bastrop, LA
National Provider Identifier
1720011588
Registry record updated Feb 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
PREMIER HOSPICE, LLC
Practice address
1513 Texas Ave
Bastrop, LA 71220-4043
Phone
(318) 556-1999
Fax
(318) 556-1997
NPI assigned
Jul 7, 2006
Last updated
Feb 7, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2013

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

Authorized official

Name
Mr. Charles G. Gladney Jr.
Title
Managing Partner
Phone
(318) 281-0078

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

1513 Texas Ave
Bastrop, LA 71220-4043

Mailing address

1523 Texas Ave
Bastrop, LA 71220-4043
Phone (318) 281-0078

Other identifiers 1

IdentifierTypeStateIssuer
1584151MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051007000105 LA Part A Provider - Hospice 8527083773 Practice locations: Bastrop, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720011588. Details of each certification follow.

Hospice certification: CCN 191615

Legal name
PREMIER HOSPICE LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Sep 13, 2005
Last certification
Sep 16, 2020
Ownership / control type
Proprietary - Other
Organization structure
LLCProprietary
Incorporated
Jun 28, 2005 in LA
Enrollment address
1513 Texas Ave
Bastrop, LA 71220-4043

Care Compare: Hospice

Medicare Care Compare
Listed as
Premier Hospice, LLCCCN 191615 · All quality measures
Ownership
For-Profit
Certified
Sep 13, 2005
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D1059902Premier Hospice1513 Texas Avenue, Bastrop, LA 71220Certificate of waiverOct 9, 2026

National Provider Directory

National Provider Directory

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

1513 Texas Ave
Bastrop, LA 71220
Phone (318) 556-1999

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Charles Gladney Individual 5% Or Greater Direct Ownership Interest Aug 15, 2005 16.31%
5% Or Greater Indirect Ownership Interest Aug 15, 2005 68.59%
Corporate Officer Aug 15, 2005 68.59%
W-2 Managing Employee Jun 28, 2005
Hospice Enterprises LLC Organization, Bastrop, LA LLC 5% Or Greater Direct Ownership Interest Aug 15, 2005 59.2%
Matthew Lyon Individual 5% Or Greater Indirect Ownership Interest Aug 15, 2005 27.41%
W-2 Managing Employee Jun 28, 2005

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Premier HospiceArcadia, LA, CCN 191659 Hospice 5% Or Greater Direct Ownership Interest (100%) Nov 20, 2007

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 11

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

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360195200000",
    "number": "1720011588",
    "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": "318-281-0078",
            "fax_number": "318-281-2753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1513 TEXAS AVE",
            "city": "BASTROP",
            "state": "LA",
            "postal_code": "712204043",
            "telephone_number": "318-556-1999",
            "fax_number": "318-556-1997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2013-02-07",
        "status": "A",
        "authorized_official_last_name": "GLADNEY",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "318-281-0078",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1584151",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bastrop, LA

Sources for this page

Verify at the official NPI Registry.