Provider Demographics
NPI:1134250210
Name:HOSPICE OF LENAWEE, INC.
Entity type:Organization
Organization Name:HOSPICE OF LENAWEE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAVENS
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CDP
Authorized Official - Phone:517-263-2323
Mailing Address - Street 1:1903 WOLF CREEK HWY
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-8460
Mailing Address - Country:US
Mailing Address - Phone:517-263-2323
Mailing Address - Fax:517-263-1425
Practice Address - Street 1:1903 WOLF CREEK HWY
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-8460
Practice Address - Country:US
Practice Address - Phone:517-263-2323
Practice Address - Fax:517-263-1425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI463510251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2720163Medicaid
MI463510OtherSTATE OF MICHIGAN LICENSE
MI08771OtherBLUE CROSS BLUE SHIELD
MI231537Medicare ID - Type UnspecifiedMEDICARE