# LHCG CCIV, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Freda H. Gordon Palliative Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205506284
- **Authorized official:** JOSHUA L PROFFITT (PRESIDENT)
- **Authorized official phone:** (337) 233-1307

## Contact information

- **Practice address:** 6477 COLLEGE PARK SQ STE 316, VIRGINIA BEACH, VA 23464-3611
- **Practice address phone:** (757) 452-6932
- **Practice address fax:** (757) 905-4316
- **Mailing address:** PO BOX 51266, LAFAYETTE, LA 70505-1266
- **Mailing address phone:** (337) 233-1307
- **Mailing address fax:** (337) 443-4154

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251G00000X | Community Based Hospice Care Agency | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 09/20/2021
- **Last updated:** 07/03/2024