Basic Information
| Provider Information | |||||||||
| NPI: | 1891108064 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| 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: | 9898912206 | ||||||||
| FaxNumber: | 9898935268 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 W OKMULGEE AVE | ||||||||
| Address2: | |||||||||
| City: | CHECOTAH | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744262413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184730505 | ||||||||
| FaxNumber: | 9188430705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2014 | ||||||||
| LastUpdateDate: | 06/05/2014 | ||||||||
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| AuthorizedOfficialLastName: | HILDEBRANT | ||||||||
| AuthorizedOfficialFirstName: | RODNEY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9898912210 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | Y | Agencies | Hospice Care, Community Based |
No ID Information.