Healthcare Provider Details

I. General information

NPI: 1518681550
Provider Name (Legal Business Name): HOSPICE CARE OF SOUTHWEST MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 11/26/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 W CENTRE AVE
PORTAGE MI
49024-4819
US

IV. Provider business mailing address

7100 STADIUM DR
KALAMAZOO MI
49009-9423
US

V. Phone/Fax

Practice location:
  • Phone: 269-345-0273
  • Fax: 269-345-8522
Mailing address:
  • Phone: 269-345-0273
  • Fax: 269-345-8522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: LEE ANN MYERS
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 313-578-6244