Provider Demographics
NPI:1437589728
Name:FAITH HOSPICE
Entity Type:Organization
Organization Name:FAITH HOSPICE
Other - Org Name:FAITH HOSPICE AT TRILLIUM WOODS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KINDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-235-5015
Mailing Address - Street 1:2100 RAYBROOK ST SE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7759
Mailing Address - Country:US
Mailing Address - Phone:616-235-5100
Mailing Address - Fax:616-235-5050
Practice Address - Street 1:8214 PFEIFFER FARMS DR SW
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-8288
Practice Address - Country:US
Practice Address - Phone:616-356-4820
Practice Address - Fax:616-356-4850
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAITH HOSPICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-22
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI413602315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI08762OtherBCBS OF MICHIGAN
MI3161730Medicaid
231570Medicare Oscar/Certification