Provider Demographics
NPI:1689624124
Name:HOSPICE QDVANTAGE, INC
Entity Type:Organization
Organization Name:HOSPICE QDVANTAGE, INC
Other - Org Name:HOME AND HOSPICE ADVANTAGE, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:KIRCHER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:810-733-9975
Mailing Address - Street 1:11503 CASTLE CT
Mailing Address - Street 2:PO BOX 465
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-1716
Mailing Address - Country:US
Mailing Address - Phone:810-564-1436
Mailing Address - Fax:
Practice Address - Street 1:1309 S LINDEN RD
Practice Address - Street 2:SUITE B
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3443
Practice Address - Country:US
Practice Address - Phone:810-733-9975
Practice Address - Fax:810-733-9476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI253520251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-1598Medicare ID - Type UnspecifiedHOSPICE