Provider Demographics
NPI:1750836664
Name:RESIDENTIAL HOSPICE, LLC
Entity Type:Organization
Organization Name:RESIDENTIAL HOSPICE, LLC
Other - Org Name:RESIDENTIAL PALLIATIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWITTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-283-8839
Mailing Address - Street 1:5440 CORPORATE DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-2646
Mailing Address - Country:US
Mailing Address - Phone:866-902-5854
Mailing Address - Fax:866-903-4000
Practice Address - Street 1:5440 CORPORATE DR
Practice Address - Street 2:SUITE 400
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-2646
Practice Address - Country:US
Practice Address - Phone:866-902-5854
Practice Address - Fax:866-903-4000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-20
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty