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General NPI Number Information
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NPI Number | 1689351280
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Entity Type | Organization
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Legal Business Name | DIVERSIFIED HOSPICE CARE, INC.
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Dates
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Enumeration Date | 07/05/2023
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Last Update Date | 07/05/2023
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Provider Practice Location Address
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Address Line | 3290 W BIG BEAVER RD STE 501
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City | TROY
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State | MI
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Zip | 48084-2911
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Country | US
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Telephone | 248-649-5489
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Fax | 248-633-4709
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Provider Business Mailing Address
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Address Line | 4234 CASCADE RD SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-8384
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Country | US
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Telephone | 248-649-5489
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Fax | 248-633-4709
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Authorized Official
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Title or Position | PRESIDENT
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Name | KRISTIAN SKOGEN
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Credential |
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Telephone | 616-464-1117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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