Basic Information
| Provider Information | |||||||||
| NPI: | 1316997950 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOSPICE ADVANTAGE, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HOME & HOSPICE ADVANTAGE, INC. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11503 CASTLE CT | ||||||||
| Address2: | PO BOX 465 | ||||||||
| City: | CLIO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484201716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8105641436 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1309 S LINDEN RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107339975 | ||||||||
| FaxNumber: | 8107339476 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KIRCHER | ||||||||
| AuthorizedOfficialFirstName: | BARBARA | ||||||||
| AuthorizedOfficialMiddleName: | LOUISE | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8107339975 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | R.N. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | MI | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | OE968 | 01 | MI | BCBSM | OTHER | 4815060 | 05 | MI | MEDICAID |