Basic Information
| Provider Information | |||||||||
| NPI: | 1518071489 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOSPICE ADVANTAGE, LLC | ||||||||
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| OtherOrganizationName: | COMPASSUS - NORTHERN MICHIGAN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 CADILLAC DRIVE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370021001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153777022 | ||||||||
| FaxNumber: | 6153734457 | ||||||||
| Practice Location | |||||||||
| Address1: | 3217 W M 76 STE B | ||||||||
| Address2: | |||||||||
| City: | WEST BRANCH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893451945 | ||||||||
| FaxNumber: | 9893451947 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 06/21/2018 | ||||||||
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| AuthorizedOfficialLastName: | ADKINS | ||||||||
| AuthorizedOfficialFirstName: | RUSSELL | ||||||||
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| AuthorizedOfficialTitleorPosition: | SVP GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 6153095668 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | MI | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 4984957 | 05 | MI | MEDICAID | 01003152 | 01 | MI | HEALTH PLUS | OTHER |