1558078865 NPI number — MI HOSPICE HOLDINGS LLC

Table of content: (NPI 1558078865)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558078865 NPI number — MI HOSPICE HOLDINGS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MI HOSPICE HOLDINGS 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:
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:
1558078865
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 AMERICA AVE UNIT 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08701-4582
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1509 S STATE RD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVISON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48423-1966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-567-0402
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GREEN
Authorized Official First Name:
DOV
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
718-635-2492

Provider Taxonomy Codes

  • Taxonomy code: 315D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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