1952456857 NPI number — HERITAGE HOME HOSPICE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952456857 NPI number — HERITAGE HOME HOSPICE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HERITAGE HOME HOSPICE, 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:
HARMONYCARES HOSPICE
Provider Other Organization Name Type Code:
3
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:
1952456857
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 99278
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48099-9278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-824-6609
Provider Business Mailing Address Fax Number:
855-618-6655

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 KIRTS BLVD
Provider Second Line Business Practice Location Address:
STE 250
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48084-4135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-837-4390
Provider Business Practice Location Address Fax Number:
248-591-0152
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHANCE
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
248-824-6000

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  1041000120 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1041000102 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1041000102 . This is a "STATE HOSPICE LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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