Provider Demographics
NPI:1376721605
Name:UNIVERSAL HOSPICE CARE, INC.
Entity Type:Organization
Organization Name:UNIVERSAL HOSPICE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-799-9225
Mailing Address - Street 1:24315 NORTHWESTERN HWY
Mailing Address - Street 2:STE# 102
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-6815
Mailing Address - Country:US
Mailing Address - Phone:248-799-9225
Mailing Address - Fax:248-799-9223
Practice Address - Street 1:24315 NORTHWESTERN HWY
Practice Address - Street 2:STE# 102
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-6815
Practice Address - Country:US
Practice Address - Phone:248-799-9225
Practice Address - Fax:248-799-9223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDO NOT REQUIRE251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-1621Medicare PIN