Healthcare Provider Details

I. General information

NPI: 1942272422
Provider Name (Legal Business Name): LAKE SUPERIOR HOSPICE ASSOCIATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 W BARAGA AVE
MARQUETTE MI
49855-4029
US

IV. Provider business mailing address

914 W BARAGA AVE
MARQUETTE MI
49855-4029
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-7760
  • Fax:
Mailing address:
  • Phone: 906-225-7760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SUE KITTI
Title or Position: CEO
Credential:
Phone: 906-225-7760