Provider Demographics
NPI:1194121962
Name:HOSPICE ADVANTAGE, LLC.
Entity type:Organization
Organization Name:HOSPICE ADVANTAGE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HILDEBRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-891-2210
Mailing Address - Street 1:401 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-5939
Mailing Address - Country:US
Mailing Address - Phone:989-891-2298
Mailing Address - Fax:989-893-5268
Practice Address - Street 1:700 S. STATE ST
Practice Address - Street 2:SUITE A.
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1749
Practice Address - Country:US
Practice Address - Phone:989-891-2210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-06
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA17401601251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA391740Medicare Oscar/Certification