1306883947 NPI number — HOSPICE ADVANTAGE, LLC

Table of content: (NPI 1306883947)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306883947 NPI number — HOSPICE ADVANTAGE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPICE ADVANTAGE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306883947
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 CADILLAC DR
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-5078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-841-4834
Provider Business Mailing Address Fax Number:
866-955-8538

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2124 KOHLER MEMORIAL DR STE 200A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHEBOYGAN
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53081-3178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-452-1851
Provider Business Practice Location Address Fax Number:
920-452-1854
Provider Enumeration Date:
06/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ADKINS
Authorized Official First Name:
RUSSELL
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP GENERAL COUNSEL
Authorized Official Telephone Number:
615-309-5668

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  2012 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 43190400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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