=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730891748
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIVINE MERCY HOME CARE SERVIECS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2022
-----------------------------------------------------
Last Update Date | 12/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1876 LINCOLN AVE
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90501-4651
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-906-5594
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4025
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90510-4025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-906-5594
-----------------------------------------------------
Fax | 424-558-3301
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MRS. IONE BERCILES NUNEZ
-----------------------------------------------------
Credential | HOME CARE PROVIDER
-----------------------------------------------------
Telephone | 310-906-5594
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------