Provider Demographics
NPI:1891413597
Name:RESIDENTIAL HOSPICE, LLC
Entity Type:Organization
Organization Name:RESIDENTIAL HOSPICE, LLC
Other - Org Name:RESIDENTIAL HOSPICE OF NW OH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / CEO
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:866-902-4000
Mailing Address - Street 1:5440 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-2645
Mailing Address - Country:US
Mailing Address - Phone:866-902-4000
Mailing Address - Fax:866-903-4000
Practice Address - Street 1:1745 INDIAN WOOD CIR STE 252
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-4168
Practice Address - Country:US
Practice Address - Phone:567-218-2075
Practice Address - Fax:866-903-4000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-18
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based