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General NPI Number Information
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NPI Number | 1124083894
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Entity Type | Organization
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Legal Business Name | DIVINE SAVIOR HEALTHCARE, INC.
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 2817 NEW PINERY RD
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City | PORTAGE
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State | WI
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Zip | 53901-9240
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Country | US
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Telephone | 608-742-4131
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Fax | 608-742-6098
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Provider Business Mailing Address
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Address Line | 29980 NETWORK PL
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City | CHICAGO
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State | IL
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Zip | 60673-1299
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Country | US
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Telephone | 608-742-4131
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Fax | 608-742-6098
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Authorized Official
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Title or Position | VP REVENUE CYCLE
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Name | MRS. LORI PECK
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Credential |
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Telephone | 715-847-2988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 3729800
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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