Provider Demographics
NPI:1275207615
Name:DIVINE SHEPERD HOSPICE CARE
Entity Type:Organization
Organization Name:DIVINE SHEPERD HOSPICE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DIVINA
Authorized Official - Middle Name:P
Authorized Official - Last Name:OCMEJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-765-2998
Mailing Address - Street 1:8220 KATELLA AVE STE 217
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:CA
Mailing Address - Zip Code:90680-3255
Mailing Address - Country:US
Mailing Address - Phone:714-765-2998
Mailing Address - Fax:714-765-2992
Practice Address - Street 1:8220 KATELLA AVE STE 217
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-3255
Practice Address - Country:US
Practice Address - Phone:714-765-2998
Practice Address - Fax:714-765-2992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-08
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based