Healthcare Provider Details

I. General information

NPI: 1861788168
Provider Name (Legal Business Name): HOSPICE ADVANTAGE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 HIGHWAY 25 S
ABERDEEN MS
39730-9033
US

IV. Provider business mailing address

401 CENTER AVE
BAY CITY MI
48708-5939
US

V. Phone/Fax

Practice location:
  • Phone: 662-841-5907
  • Fax: 662-841-5910
Mailing address:
  • Phone: 989-891-2206
  • Fax: 989-893-5268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number094
License Number StateMS

VIII. Authorized Official

Name: KAYE MYNSBERGE
Title or Position: COO
Credential:
Phone: 989-891-2210