1992892301 NPI number — HOSPICE OF JACKSON

Table of content: (NPI 1992892301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992892301 NPI number — HOSPICE OF JACKSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPICE OF JACKSON
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HENRY FORD ALLEGIANCE HOSPICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992892301
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 N EAST AVE
Provider Second Line Business Mailing Address:
ONE JACKSON SQUARE, SUITE 400
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49201-1753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-841-6982
Provider Business Mailing Address Fax Number:
517-841-6987

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 N EAST AVE
Provider Second Line Business Practice Location Address:
ONE JACKSON SQUARE, SUITE 400
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49201-1753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-841-6982
Provider Business Practice Location Address Fax Number:
517-841-6987
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP - CMO, CEO - HFAMG
Authorized Official Telephone Number:
517-205-6407

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  383510 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 70031199 . This is a "ACS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 08712 . This is a "BLUE CROSS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: HS380001 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0078 . This is a "HEALTH PLAN OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 50-20015 . This is a "PHYSICIAN'S HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1825474-16 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 500458 . This is a "CARE CHOICE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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