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General NPI Number Information
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NPI Number | 1336457324
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Entity Type | Organization
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Legal Business Name | DIVINE HOSPICE LLC
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Dates
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Enumeration Date | 09/23/2010
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Last Update Date | 09/23/2010
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Provider Practice Location Address
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Address Line | 5000 W OAKEY BLVD STE A7
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City | LAS VEGAS
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State | NV
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Zip | 89146-3394
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Country | US
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Telephone | 702-242-4663
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Fax | 702-242-4662
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Provider Business Mailing Address
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Address Line | 5000 W OAKEY BLVD STE A7
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City | LAS VEGAS
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State | NV
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Zip | 89146-3394
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Country | US
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Telephone | 702-242-4663
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Fax | 702-242-4662
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Authorized Official
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Title or Position | CEO
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Name | MR. FIDEL RAMOS NAVATA
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Credential |
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Telephone | 702-242-4663
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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 | 1010126172-001
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License Number State | NV
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