MEDICARE: DIVINE MERCY HOME 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1700018215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE MERCY HOME HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	8051 INDEPENDENCE DR
Second Line	:	STE A
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48313-3825
Country	:	US
Telephone Number	:	586-977-7953
Fax Number	:	586-977-7968

Provider Business Practice Location Address
First Line	:	8051 INDEPENDENCE DR
Second Line	:	STE A
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48313-3825
Country	:	US
Telephone Number	:	586-977-7953
Fax Number	:	586-977-7968

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	MR. FLORANTE M PEDROCHE
Credential	:	RN
Telephone Number	:	586-883-8307

Provider Enumeration Date	:	08/17/2009
Last Update Date	:	08/17/2009

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