=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538428776
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOSPICE ADVANTAGE, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2012
-----------------------------------------------------
Last Update Date | 06/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3301 RESOURCE PKWY STE 5
-----------------------------------------------------
City | DEKALB
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60115-5334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-220-1390
-----------------------------------------------------
Fax | 152-201-7228
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 CADILLAC DR SUITE 400
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37027-5078
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-377-7022
-----------------------------------------------------
Fax | 615-373-4457
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SVP GENERAL COUNSEL
-----------------------------------------------------
Name | RUSSELL ADKINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-309-5668
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number | 2002475
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------