Healthcare Provider Details

I. General information

NPI: 1801136643
Provider Name (Legal Business Name): HOSPICE ADVANTAGE, LLC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 ALLIED ST STE 105
GREEN BAY WI
54304-5542
US

IV. Provider business mailing address

10 CADILLAC DR STE 400
BRENTWOOD TN
37027-1001
US

V. Phone/Fax

Practice location:
  • Phone: 920-321-2004
  • Fax: 920-321-2005
Mailing address:
  • Phone: 615-377-7022
  • Fax: 615-373-4457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number2036
License Number StateWI

VIII. Authorized Official

Name: RUSSELL ADKINS
Title or Position: SVP GENERAL COUNSEL
Credential:
Phone: 615-309-5668