Provider Demographics
NPI:1801245048
Name:ADVISACARE HOSPICE LLC
Entity type:Organization
Organization Name:ADVISACARE HOSPICE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SKOGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-464-1117
Mailing Address - Street 1:4234 CASCADE RD SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8384
Mailing Address - Country:US
Mailing Address - Phone:616-464-1117
Mailing Address - Fax:616-464-1044
Practice Address - Street 1:1757 E BASELINE RD STE 106
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-1533
Practice Address - Country:US
Practice Address - Phone:480-284-4600
Practice Address - Fax:480-284-4688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-08
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHSPC7535251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based