Organization Active NPI

Mi Hospice Holdings LLC

Doing business as Swan Hospice

  • Inpatient Hospice
  • Flint, MI
National Provider Identifier
1558078865
Registry record updated Mar 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Inpatient HospiceTaxonomy code 315D00000X
Legal business name
MI HOSPICE HOLDINGS LLC
Doing business as
Swan Hospice
Practice address
5206 State Road
500
Flint, MI 48507-1966
Phone
(866) 865-7926
NPI assigned
Nov 7, 2022
Last updated
Mar 17, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dov Green
Title
Ceo
Phone
(908) 818-1700

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X
Inpatient Hospice 315D00000X Primary
Respite Care 385H00000X

Addresses

Primary practice location

5206 State Road
500
Flint, MI 48507-1966

Mailing address

1777 Avenue of the States Ste 106
Lakewood, NJ 08701-6205
Phone (732) 503-0364

Other names 1

  • Swan Hospice Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230301002395 MI Part A Provider - Hospice 3779956362 Practice locations: Flint, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1558078865. Details of each certification follow.

Hospice certification: CCN 231682

Legal name
MI HOSPICE HOLDINGS LLC
Doing business as
SWAN HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Aug 21, 2020
Last certification
Aug 21, 2020
Ownership / control type
Proprietary - Corporation
Organization structure
LLCProprietary
Incorporated
Jul 13, 2022 in DE
Enrollment address
5206 Gateway Ctr
Ste C
Flint, MI 48507-3920

Care Compare: Hospice

Medicare Care Compare
Listed as
Swan HospiceCCN 231682 · All quality measures
Ownership
For-Profit
Certified
Aug 21, 2020
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

5206 Gateway Ctr
Ste C
Flint, MI 48507
Phone (586) 307-4552

1777 Avenue of the States
Ste 106
Lakewood, NJ 08701
Phone (908) 818-1700

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Dov Green Individual 5% Or Greater Direct Ownership Interest Nov 1, 2022 22.34%
Corporate OfficerCeo Nov 1, 2022
Yoni Klein Individual 5% Or Greater Direct Ownership Interest Nov 1, 2022 22.33%
W-2 Managing EmployeeAdministrator Nov 1, 2022
Chana Miriam Wilhelm Individual 5% Or Greater Direct Ownership Interest Nov 1, 2022 33%
Corporate OfficerCoo Nov 1, 2022
Boruch D Mermelstein Individual 5% Or Greater Direct Ownership Interest Nov 1, 2022 22.33%

Change-of-ownership history 1

DateEventCounterparty
Nov 1, 2022 Change of OwnershipThis provider was the buyer United Hospice Care LLCCCN 231682, MI, NPI 1679034417

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1667779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742169600000",
    "number": "1558078865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1777 AVENUE OF THE STATES STE 106",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087016205",
            "telephone_number": "732-503-0364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5206 STATE ROAD",
            "address_2": "500",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485071966",
            "telephone_number": "866-865-7926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MI HOSPICE HOLDINGS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-07",
        "last_updated": "2025-03-17",
        "certification_date": "2025-03-12",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "DOV",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "908-818-1700"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "315D00000X",
            "taxonomy_group": "",
            "desc": "Hospice, Inpatient",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Swan Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Swan Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Flint, MI

Sources for this page

Verify at the official NPI Registry.