Provider Demographics
NPI:1053709279
Name:INTELICARE HOSPICE SERVICES, LLC
Entity type:Organization
Organization Name:INTELICARE HOSPICE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TONI-LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-941-9975
Mailing Address - Street 1:441 S MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:STANDISH
Mailing Address - State:MI
Mailing Address - Zip Code:48658-9480
Mailing Address - Country:US
Mailing Address - Phone:989-846-0480
Mailing Address - Fax:989-846-0482
Practice Address - Street 1:441 S MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:STANDISH
Practice Address - State:MI
Practice Address - Zip Code:48658-9480
Practice Address - Country:US
Practice Address - Phone:989-846-0480
Practice Address - Fax:989-846-0482
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTELICARE HEALTH SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based