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NPI Code Detail

MEDICARE: ANGELIC HEART HOSPICE, INC.

MEDICARE: ANGELIC HEART HOSPICE, 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
1251G00000XCommunity Based Hospice Care Agency1041000146MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245629955
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANGELIC HEART HOSPICE, INC.
Provider Business Mailing Address
First Line : 10801 S SAGINAW ST STE C
Second Line :
City : GRAND BLANC
State : MI
Zip : 48439-8126
Country : US
Telephone Number : 810-243-1910
Fax Number : 810-228-7592
Provider Business Practice Location Address
First Line : 10801 S SAGINAW ST STE C
Second Line :
City : GRAND BLANC
State : MI
Zip : 48439-8126
Country : US
Telephone Number : 810-243-1910
Fax Number : 810-228-7592
Authorized Official
Title or Position : PRESIDENT
Name : MR. ALEX MAURICIO
Credential :
Telephone Number : 801-325-0175
Provider Enumeration Date : 01/19/2015
Last Update Date : 01/24/2023

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