Provider Demographics
NPI:1609871425
Name:WINGS OF HOPE HOSPICE AND PALLIATIVE CARE, INC.
Entity Type:Organization
Organization Name:WINGS OF HOPE HOSPICE AND PALLIATIVE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-796-2676
Mailing Address - Street 1:530 LINN ST
Mailing Address - Street 2:STE A
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-1525
Mailing Address - Country:US
Mailing Address - Phone:800-796-2676
Mailing Address - Fax:269-686-9643
Practice Address - Street 1:530 LINN ST
Practice Address - Street 2:STE A
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-1525
Practice Address - Country:US
Practice Address - Phone:800-796-2676
Practice Address - Fax:269-686-9643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2831251Medicaid
MI2831251Medicaid