Healthcare Provider Details

I. General information

NPI: 1750836664
Provider Name (Legal Business Name): RESIDENTIAL HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2016
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5440 CORPORATE DR SUITE 400
TROY MI
48098-2646
US

IV. Provider business mailing address

5440 CORPORATE DR STE 400
TROY MI
48098-2645
US

V. Phone/Fax

Practice location:
  • Phone: 866-902-5854
  • Fax: 866-903-4000
Mailing address:
  • Phone: 866-902-5854
  • Fax: 866-903-4000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. LEEANN LANG
Title or Position: SENIOR VP OF ADMINISTRATION
Credential:
Phone: 866-902-5854