Provider Demographics
NPI:1518203819
Name:HOSPICE ADVANTAGE, LLC.
Entity Type:Organization
Organization Name:HOSPICE ADVANTAGE, LLC.
Other - Org Name:
Other - Org Type:
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:48708-5939
Mailing Address - Country:US
Mailing Address - Phone:989-891-2210
Mailing Address - Fax:989-893-5268
Practice Address - Street 1:5651 WHITESVILLE RD
Practice Address - Street 2:STE 110
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9083
Practice Address - Country:US
Practice Address - Phone:706-649-5899
Practice Address - Fax:989-893-5268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI044-0367-H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111730Medicare Oscar/Certification