- Enrollment id
- O20230828000279
- Enrollment state
- MI
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1669168563
- Multiple npi flag
- N
- Ccn
- 231724
- Associate id
- 2264895069
- Organization name
- PROACTIVE HOSPICE CARE LLC
- Incorporation date
- 2023-04-12
- Incorporation state
- MI
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 52188 VAN DYKE AVE
- Address line 2
- STE 201A
- City
- SHELBY TOWNSHIP
- State
- MI
- Zip code
- 483163569