Provider Demographics
NPI:1689616054
Name:HOSPICE OF MICHIGAN, INC.
Entity type:Organization
Organization Name:HOSPICE OF MICHIGAN, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LEE ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-578-6244
Mailing Address - Street 1:2366 OAK VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-8944
Mailing Address - Country:US
Mailing Address - Phone:248-353-2070
Mailing Address - Fax:
Practice Address - Street 1:400 GALLERIA OFFICENTRE STE 400
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-2162
Practice Address - Country:US
Practice Address - Phone:248-353-2070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI151796120Medicaid
MI08756OtherBLUE CROSS BLUE SHIELD
MI151796120Medicaid