Healthcare Provider Details

I. General information

NPI: 1376468579
Provider Name (Legal Business Name): MICHIGAN COMMUNITY VNA HOSPICE OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30800 TELEGRAPH RD STE 1728
BINGHAM FARMS MI
48025-5703
US

IV. Provider business mailing address

30800 TELEGRAPH RD STE 1728
BINGHAM FARMS MI
48025-5703
US

V. Phone/Fax

Practice location:
  • Phone: 248-967-1440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: BRIAN TAIT
Title or Position: CFO
Credential:
Phone: 815-980-1254