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General NPI Number Information
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NPI Number | 1083234900
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Entity Type | Organization
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Legal Business Name | DIVINE GRACE HEALTHCARE, INC.
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Dates
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Enumeration Date | 04/21/2020
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 515 N SAM HOUSTON PKWY E STE 320
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City | HOUSTON
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State | TX
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Zip | 77060-4139
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Country | US
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Telephone | 281-809-3123
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Fax | 877-313-0955
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Provider Business Mailing Address
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Address Line | 515 N SAM HOUSTON PKWY E STE 320
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City | HOUSTON
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State | TX
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Zip | 77060-4139
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Country | US
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Telephone | 281-809-3123
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Fax | 877-313-0955
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CAROL S PITTS
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Credential |
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Telephone | 713-705-2443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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