Provider Demographics
NPI:1134459084
Name:HOSPICE ADVANTAGE, LLC.
Entity Type:Organization
Organization Name:HOSPICE ADVANTAGE, LLC.
Other - Org Name:HOSPICE ADVANTAGE, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KAYANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MYNSBERGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-891-2212
Mailing Address - Street 1:401 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-5939
Mailing Address - Country:US
Mailing Address - Phone:989-891-2206
Mailing Address - Fax:989-893-5268
Practice Address - Street 1:2435 1ST AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:IRONDALE
Practice Address - State:AL
Practice Address - Zip Code:35210
Practice Address - Country:US
Practice Address - Phone:205-970-3888
Practice Address - Fax:205-970-6677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-28
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALE3722251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL011630Medicare Oscar/Certification