Provider Demographics
NPI:1053314252
Name:HOSPICE ALLIANCE, INC.
Entity Type:Organization
Organization Name:HOSPICE ALLIANCE, INC.
Other - Org Name:ALLIANCE HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-652-4482
Mailing Address - Street 1:10220 PRAIRIE RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53158-1946
Mailing Address - Country:US
Mailing Address - Phone:262-652-4400
Mailing Address - Fax:262-925-1361
Practice Address - Street 1:10220 PRAIRIE RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANT PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53158-1946
Practice Address - Country:US
Practice Address - Phone:262-652-4400
Practice Address - Fax:262-925-1361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI130251E00000X
WI1502251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43180700Medicaid
WI41510300Medicaid
WI=========OtherHOSPICE & HOME HEALTH
WI41510300Medicaid
WI527147Medicare Oscar/Certification