Provider Demographics
NPI:1578176038
Name:INTELICARE HOSPICE SERVICES III, LLC
Entity Type:Organization
Organization Name:INTELICARE HOSPICE SERVICES III, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TONI LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-941-9975
Mailing Address - Street 1:6501 CONGRESS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2840
Mailing Address - Country:US
Mailing Address - Phone:561-877-2132
Mailing Address - Fax:561-880-6939
Practice Address - Street 1:6060 TORREY RD STE J
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-5963
Practice Address - Country:US
Practice Address - Phone:810-219-2001
Practice Address - Fax:810-219-2072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based