MEDICARE: HOSPICE ANGELIC CARE

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	4704208260	MI

General Provider Information

NPI Number	:	1639317605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPICE ANGELIC CARE

Provider Business Mailing Address
First Line	:	PO BOX 33
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48764-0033
Country	:	US
Telephone Number	:	989-525-1900
Fax Number	:	989-362-8429

Provider Business Practice Location Address
First Line	:	910 N TAWAS LAKE RD
Second Line	:
City	:	EAST TAWAS
State	:	MI
Zip	:	48730-9772
Country	:	US
Telephone Number	:	989-525-1900
Fax Number	:	989-362-8429

Authorized Official
Title or Position	:	OWNER
Name	:	MS. MELANIE R HAYES
Credential	:	RN
Telephone Number	:	989-525-1900

Provider Enumeration Date	:	01/29/2009
Last Update Date	:	01/29/2009

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