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General NPI Number Information
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NPI Number | 1376978833
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Entity Type | Organization
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Legal Business Name | DIVINE MERCY SUPPORTIVE CARE
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Dates
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Enumeration Date | 09/03/2013
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Last Update Date | 04/29/2016
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Provider Practice Location Address
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Address Line | 4045 PECOS ST
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City | DENVER
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State | CO
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Zip | 80211-2552
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Country | US
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Telephone | 303-357-2540
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Fax | 720-398-3490
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Provider Business Mailing Address
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Address Line | 303 S BROADWAY #220
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City | DENVER
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State | CO
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Zip | 80209-1558
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Country | US
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Telephone | 303-357-2540
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. KEVIN LUNDY
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Credential |
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Telephone | 303-357-2540
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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 | 17M599
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License Number State | CO
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