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General NPI Number Information
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NPI Number | 1548523186
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Entity Type | Organization
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Legal Business Name | HOSPICE OF JACKSON - HOSPICE HOME
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Dates
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Enumeration Date | 06/19/2012
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Last Update Date | 08/09/2019
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Provider Practice Location Address
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Address Line | 2150 KINGSBROOKE DR
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City | JACKSON
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State | MI
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Zip | 49202-1300
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Country | US
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Telephone | 517-817-7600
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Fax | 517-817-7615
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Provider Business Mailing Address
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Address Line | 2150 KINGSBROOKE DR
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City | JACKSON
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State | MI
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Zip | 49202-1300
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Country | US
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Telephone | 517-817-7600
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Fax | 517-817-7615
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Authorized Official
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Title or Position | SVP - CMO, CEO - HFAMG
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Name | MRS. MARK SMITH
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Credential | MD
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Telephone | 517-205-6407
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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 | 1050000017
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 315D00000X
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Taxonomy Name | Inpatient Hospice
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License Number | 1070000432
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License Number State | MI
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