Provider Demographics
NPI:1477526036
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:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:D
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-425-5418
Mailing Address - Street 1:10 CADILLAC DRIVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-1001
Mailing Address - Country:US
Mailing Address - Phone:615-377-7022
Mailing Address - Fax:615-373-4457
Practice Address - Street 1:30700 TELEGRAPH RD
Practice Address - Street 2:SUITE 3450
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4524
Practice Address - Country:US
Practice Address - Phone:248-440-1301
Practice Address - Fax:248-440-1303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI633539251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI08736OtherBLUE CROSS OF MICHIGAN
MI154827140Medicaid
MI01002978OtherHEALTH PLUS OF MICHIGAN
MI08736OtherBLUE CROSS OF MICHIGAN