MEDICARE: DIVINE MERCY HOSPICE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1245427699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE MERCY HOSPICE, PLLC

Provider Business Mailing Address
First Line	:	1234 CHESTNUT ST STE 114
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02464-1491
Country	:	US
Telephone Number	:	434-977-9711
Fax Number	:	434-235-4142

Provider Business Practice Location Address
First Line	:	400 S ZANG BLVD STE 1220
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75208
Country	:	US
Telephone Number	:	817-225-2591
Fax Number	:	817-225-2503

Authorized Official
Title or Position	:	CHIEF ADMINISTRATIVE OFFICER
Name	:	JESSE R MOORE
Credential	:
Telephone Number	:	857-331-6271

Provider Enumeration Date	:	10/01/2007
Last Update Date	:	01/29/2025

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