Healthcare Provider Details

I. General information

NPI: 1730113234
Provider Name (Legal Business Name): DIVINE PROVIDENCE HEATLH CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 E GEORGE ST
IVANHOE MN
56142-9707
US

IV. Provider business mailing address

312 E GEORGE ST PO BOX 136
IVANHOE MN
56142-9707
US

V. Phone/Fax

Practice location:
  • Phone: 507-694-1414
  • Fax:
Mailing address:
  • Phone: 507-694-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number331268
License Number StateMN

VIII. Authorized Official

Name: MRS. CHERYL LYNN VERSCHELDE
Title or Position: ADMINISTRATOR/CEO
Credential:
Phone: 507-694-2010