MEDICARE: DIVINE HOSPICE GROUP, 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	:	1942878590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE HOSPICE GROUP, INC.

Provider Business Mailing Address
First Line	:	13749 VICTORY BLVD # M
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91401-2348
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13749 VICTORY BLVD # M
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91401-2348
Country	:	US
Telephone Number	:	818-601-8844
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KARINE SIGAL
Credential	:
Telephone Number	:	818-601-8844

Provider Enumeration Date	:	06/10/2021
Last Update Date	:	06/10/2021

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