Healthcare Provider Details

I. General information

NPI: 1487608063
Provider Name (Legal Business Name): HOSPICE ADVANTAGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 QUAIL CT
PEWAUKEE WI
53072-3780
US

IV. Provider business mailing address

401 CENTER AVE
BAY CITY MI
48708-5962
US

V. Phone/Fax

Practice location:
  • Phone: 262-786-9002
  • Fax: 262-786-9003
Mailing address:
  • Phone: 989-891-2206
  • Fax: 989-893-5268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KAYANNE MYNSBERGE
Title or Position: COO
Credential:
Phone: 262-786-9002