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General NPI Number Information
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NPI Number | 1205261070
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Entity Type | Organization
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Legal Business Name | DIVINE CARE HOSPICE INC
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Dates
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Enumeration Date | 09/11/2013
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Last Update Date | 03/03/2014
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Provider Practice Location Address
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Address Line | 7177 BROCKTON AVE STE 224
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City | RIVERSIDE
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State | CA
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Zip | 92506-2633
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Country | US
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Telephone | 951-222-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 7177 BROCKTON AVE STE 224
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City | RIVERSIDE
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State | CA
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Zip | 92506-2633
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Country | US
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Telephone | 951-222-0300
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. LAARNI DIZON
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Credential |
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Telephone | 951-222-0300
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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 | 1231574
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License Number State | CA
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