Provider Demographics
NPI:1558613281
Name:CUSTOM HOSPICE, LLC
Entity Type:Organization
Organization Name:CUSTOM HOSPICE, LLC
Other - Org Name:ADVANCED PRO HOSPICE, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSSEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-582-7400
Mailing Address - Street 1:888 W BIG BEAVER RD STE 900
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4771
Mailing Address - Country:US
Mailing Address - Phone:248-582-7400
Mailing Address - Fax:248-809-5824
Practice Address - Street 1:888 W BIG BEAVER RD STE 900
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4771
Practice Address - Country:US
Practice Address - Phone:248-582-7400
Practice Address - Fax:248-809-5824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
231638Medicare Oscar/Certification