MEDICARE: HOSPICE OF MUSKEGON COUNTY, 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	613510	MI
2	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	231508	OTHER	MI	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	500449	OTHER	MI	CARE CHOICES
2	52230	OTHER	MI	COMMUNITY CHOICE
4	08701	OTHER	MI	BCBS OF MI
5	7402461	OTHER	MI	AETNA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740283787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOSPICE OF MUSKEGON COUNTY, INC.

Provider Business Mailing Address
First Line	:	1050 W WESTERN AVE
Second Line	:	STE 400
City	:	MUSKEGON
State	:	MI
Zip	:	49441-1666
Country	:	US
Telephone Number	:	231-728-3442
Fax Number	:	231-726-2581

Provider Business Practice Location Address
First Line	:	1050 W WESTERN AVE
Second Line	:	STE 400
City	:	MUSKEGON
State	:	MI
Zip	:	49441-1666
Country	:	US
Telephone Number	:	231-728-3442
Fax Number	:	231-726-2581

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	SUSAN HOUSEMAN
Credential	:	RN, BSN, NHA
Telephone Number	:	231-728-6820

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	04/13/2023

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