| Organization Name: | PREMIER HOSPICE OF MANGHAM, LLC |
| NPI Number: | 1093905762 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHARLES GOODWIN GLADNEY (MANAGING PARTNER) |
| Mailing Address: | 104-2 West Bayou Farmerville |
| State: | LA US |
| Postal Code: | 71241 |
| Phone Number: | 3182810000 |
| Fax Number: | 3182812753 |
| NPI Enumeration Date: | 07/30/2007 |
| NPI Last Update Date: | 07/30/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251G00000X |
| License Number: | TBD |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Hospice Care, Community Based |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |