Provider Demographics
NPI:1104223106
Name:DIVINE HOSPICE AND PALLIATIVE CARE LLC
Entity Type:Organization
Organization Name:DIVINE HOSPICE AND PALLIATIVE CARE LLC
Other - Org Name:DIVINE HOSPICE AND PALLIATIVE CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RIKESH
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-566-7995
Mailing Address - Street 1:18185 N 83RD AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-0523
Mailing Address - Country:US
Mailing Address - Phone:623-566-7995
Mailing Address - Fax:602-733-6487
Practice Address - Street 1:18185 N 83RD AVE STE 203
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-0523
Practice Address - Country:US
Practice Address - Phone:623-566-7995
Practice Address - Fax:602-733-6487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based