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General NPI Number Information
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NPI Number | 1043063357
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Entity Type | Organization
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Legal Business Name | IDEAL HOSPICE SERVICES INC
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Dates
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Enumeration Date | 04/08/2024
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 6751 DIXIE HWY STE 200
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City | CLARKSTON
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State | MI
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Zip | 48346-2080
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Country | US
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Telephone | 888-761-1215
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Fax | 866-635-3078
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Provider Business Mailing Address
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Address Line | 6751 DIXIE HWY STE 200
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City | CLARKSTON
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State | MI
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Zip | 48346-2080
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Country | US
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Telephone | 888-761-1215
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Fax | 866-635-3078
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Authorized Official
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Title or Position | PRESIDENT/ADMINISTRATOR
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Name | DIPA SHAH
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Credential | ADMINISTRATOR
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Telephone | 810-449-0916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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