Provider Demographics
NPI:1083851646
Name:DIVINE MERCY HOSPICE INC
Entity Type:Organization
Organization Name:DIVINE MERCY HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-324-4663
Mailing Address - Street 1:PO BOX 1465
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1465
Mailing Address - Country:US
Mailing Address - Phone:248-324-4663
Mailing Address - Fax:248-324-4664
Practice Address - Street 1:2820 W MAPLE RD STE 201A
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-7064
Practice Address - Country:US
Practice Address - Phone:248-324-4663
Practice Address - Fax:248-324-4664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-19
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based