Healthcare Provider Details

I. General information

NPI: 1437517547
Provider Name (Legal Business Name): DIVINE HOSPICE & PALLIATIVE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GARDEN ST
YORKVILLE IL
60560-8921
US

IV. Provider business mailing address

234 GARDEN ST
YORKVILLE IL
60560-8921
US

V. Phone/Fax

Practice location:
  • Phone: 630-553-8500
  • Fax: 888-977-3195
Mailing address:
  • Phone: 630-553-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: BINU GEORGE
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 630-553-8500