Healthcare Provider Details

I. General information

NPI: 1114202967
Provider Name (Legal Business Name): SIGNATURE HOSPICE OF MICHIGAN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29400 VAN DYKE AVE
WARREN MI
48093-2320
US

IV. Provider business mailing address

29400 VAN DYKE AVE
WARREN MI
48093-2320
US

V. Phone/Fax

Practice location:
  • Phone: 810-620-4579
  • Fax: 586-486-5976
Mailing address:
  • Phone: 810-620-4579
  • Fax: 586-486-5976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: NISHAT ASHFAQ
Title or Position: PRESIDENT/ADMINISTRATOR
Credential:
Phone: 810-620-4579