Basic Information
| Provider Information | |||||||||
| NPI: | 1750494514 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOSPICE ADVANTAGE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 CADILLAC DR | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370275078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153777022 | ||||||||
| FaxNumber: | 6153734457 | ||||||||
| Practice Location | |||||||||
| Address1: | 220 N STATE ROUTE 7 | ||||||||
| Address2: | |||||||||
| City: | PLEASANT HILL | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640801426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162282500 | ||||||||
| FaxNumber: | 8167957818 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2006 | ||||||||
| LastUpdateDate: | 12/19/2017 | ||||||||
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| AuthorizedOfficialLastName: | JAMES | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6154255418 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | HO-161 | MO | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 826304008 | 05 | MO | MEDICAID |