=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487844981
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARBOR HOSPICE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2007
-----------------------------------------------------
Last Update Date | 07/31/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2366 OAK VALLEY DR
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48103-8944
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-794-5113
-----------------------------------------------------
Fax | 734-662-9000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2366 OAK VALLEY DR
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48103-8944
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-794-5113
-----------------------------------------------------
Fax | 734-662-9000
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT & CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | GLORIA D BROOKS
-----------------------------------------------------
Credential | MPA, CHCE
-----------------------------------------------------
Telephone | 734-794-5113
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------