Basic Information
| Provider Information | |||||||||
| NPI: | 1669753356 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOSPICE ADVANTAGE, LLC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HOSPICE ADVANTAGE, INC. | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 CENTER AVE | ||||||||
| Address2: | |||||||||
| City: | BAY CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487085939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9898912206 | ||||||||
| FaxNumber: | 9898935268 | ||||||||
| Practice Location | |||||||||
| Address1: | 280 S THOMAS ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | TUPELO | ||||||||
| State: | MS | ||||||||
| PostalCode: | 388014302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6628403434 | ||||||||
| FaxNumber: | 6626804592 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2011 | ||||||||
| LastUpdateDate: | 01/11/2013 | ||||||||
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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 | 071 | MS | Y | Agencies | Hospice Care, Community Based |
No ID Information.