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General NPI Number Information
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NPI Number | 1245629955
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Entity Type | Organization
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Legal Business Name | ANGELIC HEART HOSPICE, INC.
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Dates
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Enumeration Date | 01/19/2015
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Last Update Date | 01/24/2023
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Provider Practice Location Address
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Address Line | 10801 S SAGINAW ST STE C
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City | GRAND BLANC
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State | MI
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Zip | 48439-8126
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Country | US
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Telephone | 810-243-1910
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Fax | 810-228-7592
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Provider Business Mailing Address
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Address Line | 10801 S SAGINAW ST STE C
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City | GRAND BLANC
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State | MI
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Zip | 48439-8126
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Country | US
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Telephone | 810-243-1910
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Fax | 810-228-7592
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ALEX MAURICIO
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Credential |
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Telephone | 801-325-0175
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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 | 1041000146
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License Number State | MI
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