Basic Information
| Provider Information | |||||||||
| NPI: | 1518203819 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOSPICE ADVANTAGE, LLC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 CENTER AVE | ||||||||
| Address2: | |||||||||
| City: | BAY CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487085939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898912210 | ||||||||
| FaxNumber: | 9898935268 | ||||||||
| Practice Location | |||||||||
| Address1: | 5651 WHITESVILLE RD | ||||||||
| Address2: | STE 110 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319049083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066495899 | ||||||||
| FaxNumber: | 9898935268 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2012 | ||||||||
| LastUpdateDate: | 12/14/2012 | ||||||||
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| AuthorizedOfficialLastName: | MYNSBERGE | ||||||||
| AuthorizedOfficialFirstName: | KAYANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 9898912210 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 044-0367-H | MI | Y | Agencies | Hospice Care, Community Based |
No ID Information.