Provider Demographics
NPI:1790896090
Name:ADVOCATE HOSPICE LLC
Entity Type:Organization
Organization Name:ADVOCATE HOSPICE LLC
Other - Org Name:ADVOCATE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:DWIGHT
Authorized Official - Last Name:ADDISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-745-5147
Mailing Address - Street 1:2605 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-8468
Mailing Address - Country:US
Mailing Address - Phone:317-745-5147
Mailing Address - Fax:317-745-5936
Practice Address - Street 1:2605 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-8468
Practice Address - Country:US
Practice Address - Phone:317-745-5147
Practice Address - Fax:317-745-5936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN004875251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN151594Medicare ID - Type UnspecifiedPROVIDER NUMBER