Provider Demographics
NPI:1104058783
Name:HOSPICE ANGELIC CARE INC.
Entity type:Organization
Organization Name:HOSPICE ANGELIC CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:989-362-6600
Mailing Address - Street 1:430 W M 55
Mailing Address - Street 2:SUITE B
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48763-9239
Mailing Address - Country:US
Mailing Address - Phone:989-362-6600
Mailing Address - Fax:989-362-6605
Practice Address - Street 1:430 W M 55
Practice Address - Street 2:SUITE B
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763-9239
Practice Address - Country:US
Practice Address - Phone:989-362-6600
Practice Address - Fax:989-362-6605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-17
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1041000108251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI231614Medicare Oscar/Certification