Healthcare Provider Details

I. General information

NPI: 1194890814
Provider Name (Legal Business Name): OP HOSPICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24293 TELEGRAPH RD SUITE 102
SOUTHFIELD MI
48034-3011
US

IV. Provider business mailing address

24293 TELEGRAPH RD SUITE 102
SOUTHFIELD MI
48034-3011
US

V. Phone/Fax

Practice location:
  • Phone: 800-311-5365
  • Fax:
Mailing address:
  • Phone: 800-311-5365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State

VIII. Authorized Official

Name: MS. LAURA WAGNER
Title or Position: PRESIDENT
Credential:
Phone: 800-311-5365