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General NPI Number Information
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NPI Number | 1801886239
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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 | 10/26/2005
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 2805 HUNTERS TRAIL DBA ASPIRUS TIVOLI COMMUNITY
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City | PORTAGE
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State | WI
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Zip | 53901-0387
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Country | US
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Telephone | 608-742-4131
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Fax | 608-745-5997
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Provider Business Mailing Address
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Address Line | 29980 NETWORK PL DIVINE SAVIOR HEALTHCARE EXTENDED CARE
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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 |
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Fax |
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Authorized Official
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Title or Position | SVP & CHIEF FINANCIAL OFFICER
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Name | MRS. JERRY M YANG
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Credential |
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Telephone | 715-847-2526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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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 | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 2017
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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