Provider Demographics
NPI:1255647350
Name:MICHIGAN HOSPICE,INC.
Entity type:Organization
Organization Name:MICHIGAN HOSPICE,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHFAQ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-625-3355
Mailing Address - Street 1:4870 W CLARK RD
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1104
Mailing Address - Country:US
Mailing Address - Phone:734-677-0077
Mailing Address - Fax:734-677-0079
Practice Address - Street 1:4870 W CLARK RD
Practice Address - Street 2:SUITE 100B
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1104
Practice Address - Country:US
Practice Address - Phone:734-677-0077
Practice Address - Fax:734-677-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-26
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-1624Medicare PIN