CUSTOM HOSPICE, LLC (NPI# 1306480538) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306480538 |
| Entity Type | Organization |
| Organization Name | CUSTOM HOSPICE, LLC |
| Practice Address |
888 W Big Beaver Rd Ste 900 Troy MI 48084-4771 |
| Practice Telephone | 8669529003 |
| Practice Fax Number | 8669529004 |
| Mailing Telephone | 8669529003 |
| Mailing Fax Number | 8669529004 |
| Enumeration Date | 2019-10-31 |
| Last Update Date | 2019-10-31 |
| Authorized Official Name | SEAN FOSSEE (CEO) |
| Authorized Official Telephone | 2486292880 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
Physician Assistants & Advanced Practice Nursing Providers |
| Other Name | Type Code |
|---|---|
| Custom Palliative Care | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558613281 | Custom Hospice, LLC | Hospice Care, Community Based | 928 E 11 Mile Rd, Royal Oak, MI 48067-1968 | 2012-10-04 |
| Street Address |
888 W BIG BEAVER RD STE 900 |
| City | TROY |
| State | MI |
| Zip Code | 48084-4771 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265806939 | Tammy Scott-barney | Nurse Practitioner | 888 W Big Beaver Rd Ste 900, Troy, MI 48084 | 2015-11-18 |
| 1043820178 | Dorian R. Michelson Axiak | Nurse Practitioner | 888 W Big Beaver Rd Ste 900, Troy, MI 48084-4771 | 2020-08-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497360242 | Keely Erin Zuri | Physical Therapy Assistant | 3250 W. Big Beaver, Troy, MI 48084 | 2020-09-09 |
| 1841762473 | Hunter Thomas Michaels | Kinesiotherapist | 3250 West Big Beaver Rd, Suite 228, Troy, MI 48084 | 2018-12-20 |
| 1265900864 | Michelle Denise Carter | Massage Therapist | 3250 West Big Beaver Suite 228, Troy, MI 48084 | 2018-11-13 |
| 1770083925 | Troy Daniel Burrell | Clinical Exercise Physiologist | 3250 West Big Beaver Rd, Suite 228, Troy, MI 48084 | 2018-02-14 |
| 1174030175 | Alexander Scott | Kinesiotherapist | 3250 W. Big Beaver Rd., Troy, MI 48084 | 2017-12-29 |
| 1568977213 | Mallory Rose Valeri | Specialist/Technologist | 3250 W. Big Beaver Rd, Suite 228, Troy, MI 48084 | 2017-12-04 |
| 1710409651 | Eduardo Martin Pinto | Pharmacist | 3811 Coolidge Hwy, Troy, MI 48084 | 2017-07-12 |
| 1659891653 | Tricia Michelle Forgash | Recreation Therapist | 1998 Dorchester Dr. N 106, Troy, MI 48084 | 2017-06-21 |
| 1851759278 | Lauren Field | Counselor | 3290 W Big Beaver Rd Ste 188, Troy, MI 48084 | 2016-01-30 |
| 1083084669 | Camler Medical LLC | Durable Medical Equipment & Medical Supplies | 100 West Big Beaver Rd, Suite 200, Troy, MI 48084 | 2015-09-25 |
| Find all providers in zip 48084 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437782067 | Jamie Lynn Kosalsky | Nurse Practitioner | 1385 Cadmus Dr, Troy, MI 48085-1218 | 2020-02-21 |
| 1770981037 | Aimee Dennis | Nurse Practitioner | 880 W Long Lake Rd # 600, Troy, MI 48098-4504 | 2014-12-18 |
| 1033549381 | Jodie Eickhoff | Nurse Practitioner | 6535 Rochester Rd Ste 2, Troy, MI 48085-1362 | 2013-11-24 |
| 1912337551 | Grace Wang | Nurse Practitioner | 2883 Creek Bend Dr, Troy, MI 48098-2381 | 2013-11-18 |
| 1023326881 | Bernadette Sarah Below | Nurse Practitioner | 2095 E Big Beaver Rd Ste 375, Troy, MI 48083-2374 | 2010-09-15 |
| 1841516432 | Lynne Longtin | Nurse Practitioner | 74 Ferry St, Troy, NY 12180 | 2010-04-08 |
| 1942525522 | Joann Barhorst | Nurse Practitioner | 1300 N County Road 25a, Troy, OH 45373-1359 | 2010-04-07 |
| 1982898326 | Cassandra L Lutes | Nurse Practitioner | 215 Highway Aa, Troy, MO 63379 | 2007-08-29 |
| 1467490870 | Jessica Elizabeth Niehoff | Nurse Practitioner | 104 Sarah Ann Blvd, Troy, MO 63379-2038 | 2006-06-04 |
| 1265032445 | Jenni Layne Bolton | Nurse Practitioner | 550 Summit Ave Ste 101, Troy, OH 45373-3047 | 2020-10-28 |
| Find all providers in TROY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.