Provider Demographics
NPI:1235197401
Name:HOSPICE CARE OF SOUTHWEST MICHIGAN
Entity Type:Organization
Organization Name:HOSPICE CARE OF SOUTHWEST MICHIGAN
Other - Org Name:HOSPICE OF GREATER KALAMAZOO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-345-0273
Mailing Address - Street 1:222 N KALAMAZOO MALL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-3882
Mailing Address - Country:US
Mailing Address - Phone:269-345-0273
Mailing Address - Fax:269-345-8522
Practice Address - Street 1:222 N KALAMAZOO MALL
Practice Address - Street 2:SUITE 100
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3881
Practice Address - Country:US
Practice Address - Phone:269-345-0273
Practice Address - Fax:269-345-8522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI393510251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI08710OtherBLUE CROSS BLUE SHIELD
MI1791732Medicaid
MI1791732Medicaid