Healthcare Provider Details

I. General information

NPI: 1689351280
Provider Name (Legal Business Name): DIVERSIFIED HOSPICE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3290 W BIG BEAVER RD STE 501
TROY MI
48084-2911
US

IV. Provider business mailing address

4234 CASCADE RD SE
GRAND RAPIDS MI
49546-8384
US

V. Phone/Fax

Practice location:
  • Phone: 248-649-5489
  • Fax: 248-633-4709
Mailing address:
  • Phone: 248-649-5489
  • Fax: 248-633-4709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KRISTIAN SKOGEN
Title or Position: PRESIDENT
Credential:
Phone: 616-464-1117