MEDICARE: HOSPICE ANGELIC CARE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	1041000108	MI

General Provider Information

NPI Number	:	1104058783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPICE ANGELIC CARE INC.

Provider Business Mailing Address
First Line	:	430 W M 55
Second Line	:	SUITE B
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-9239
Country	:	US
Telephone Number	:	989-362-6600
Fax Number	:	989-362-6605

Provider Business Practice Location Address
First Line	:	430 W M 55
Second Line	:	SUITE B
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-9239
Country	:	US
Telephone Number	:	989-362-6600
Fax Number	:	989-362-6605

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. MELANIE R HAYES
Credential	:	RN
Telephone Number	:	989-362-6600

Provider Enumeration Date	:	08/17/2009
Last Update Date	:	04/06/2010

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