Provider Demographics
NPI:1437126265
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:989-891-2210
Mailing Address - Street 1:401 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-5962
Mailing Address - Country:US
Mailing Address - Phone:989-891-2206
Mailing Address - Fax:989-893-5268
Practice Address - Street 1:1309 S LINDEN RD
Practice Address - Street 2:SUITE B
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3443
Practice Address - Country:US
Practice Address - Phone:810-733-9975
Practice Address - Fax:810-733-9476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-01
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI253520251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI15-4844384Medicaid
MI08745OtherBLUE CROSS OF MICHIGAN
MI01002968OtherHEALTH PLUS OF MICHIGAN
MI231598Medicare ID - Type UnspecifiedMEDICARE NUMBER