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General NPI Number Information
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NPI Number | 1558613281
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Entity Type | Organization
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Legal Business Name | CUSTOM HOSPICE, LLC
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Dates
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Enumeration Date | 10/04/2012
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Last Update Date | 03/18/2021
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Provider Practice Location Address
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Address Line | 888 W BIG BEAVER RD STE 900
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City | TROY
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State | MI
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Zip | 48084-4771
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Country | US
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Telephone | 248-582-7400
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Fax | 248-809-5824
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Provider Business Mailing Address
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Address Line | 888 W BIG BEAVER RD STE 900
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City | TROY
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State | MI
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Zip | 48084-4771
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Country | US
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Telephone | 248-582-7400
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Fax | 248-809-5824
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Authorized Official
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Title or Position | OWNER
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Name | SEAN FOSSEE
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Credential |
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Telephone | 248-582-7400
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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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