MEDICARE: DIVINE PALLIATIVE AND HEALTH SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1144602384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE PALLIATIVE AND HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	10039 BISSONNET ST STE 148
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-7863
Country	:	US
Telephone Number	:	713-835-4703
Fax Number	:

Provider Business Practice Location Address
First Line	:	10039 BISSONNET ST STE 148
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-7863
Country	:	US
Telephone Number	:	713-835-4703
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CHIDUBEM CHIWUZIE
Credential	:
Telephone Number	:	713-835-4703

Provider Enumeration Date	:	06/24/2015
Last Update Date	:	06/24/2015

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