NPIMap

Organization Active NPI

Diversified Hospice Care, Inc.

  • Community Based Hospice Care Agency
  • Troy, MI
National Provider Identifier
1972865079
Registry record updated May 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
DIVERSIFIED HOSPICE CARE, INC.
Practice address
3290 W Big Beaver Rd Ste 501
Troy, MI 48084-2911
Phone
(248) 633-8488
Fax
(866) 444-0304
NPI assigned
Jun 13, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2019

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

Authorized official

Name
Mr. Kristian Skogen
Title
President
Phone
(616) 464-1117

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

3290 W Big Beaver Rd Ste 501
Troy, MI 48084-2911

Mailing address

4234 Cascade Rd SE
Grand Rapids, MI 49546-8384
Phone (616) 464-1117

Other names 1

  • AdvisaCare Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180504002099 MI Part A Provider - Hospice 6901061787 Practice locations: Troy, MI

Hospice certification: CCN 231530

Legal name
DIVERSIFIED HOSPICE CARE, INC.
Doing business as
ADVISACARE HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Sep 30, 1988
Last certification
Oct 29, 2020
Ownership / control type
Proprietary - Individual
Organization structure
CorporationProprietary
Incorporated
Mar 4, 2011 in MI
Enrollment address
3290 W Big Beaver Rd
Ste 501
Troy, MI 48084-2911

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospice

Medicare Care Compare
Listed as
Advisacare HospiceCCN 231530
Ownership
For-Profit
Certified
Sep 30, 1988
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Advisacare Hospice2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Kristian E Skogen Individual 5% Or Greater Indirect Ownership Interest Apr 2, 2018 100%
Corporate OfficerPresident, Board Member Apr 2, 2018
Corporate DirectorPresident, Board Member Apr 2, 2018
Eric Clauw Individual W-2 Managing EmployeeAd; Nov 18, 2024
Advisacare Healthcare Solutions, Inc. Organization, Grand Rapids, MI Corporation, Medical provider/supplier, For-profit 5% Or Greater Direct Ownership Interest Apr 2, 2018 100%
Susan H Longe Individual Contracted Managing EmployeeMD; Apr 2, 2018
Lise' M Reigler Individual Corporate OfficerCfo, Board Member Apr 2, 2018
Corporate DirectorCfo, Board Member Apr 2, 2018
Jean a Pattee Individual W-2 Managing EmployeeExecutive Dir. of Clinical Op Dec 5, 2022

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 6

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1339545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557878400000",
    "number": "1972865079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4234 CASCADE RD SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468384",
            "telephone_number": "616-464-1117",
            "fax_number": "616-464-1044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3290 W BIG BEAVER RD STE 501",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480842911",
            "telephone_number": "248-633-8488",
            "fax_number": "866-444-0304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSIFIED HOSPICE CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-13",
        "last_updated": "2019-05-15",
        "status": "A",
        "authorized_official_last_name": "SKOGEN",
        "authorized_official_first_name": "KRISTIAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "616-464-1117",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AdvisaCare Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Troy, MI

Sources for this page

Verify at the official NPI Registry.