Provider Demographics
NPI:1326580671
Name:DIVINE CARE SERVICES OF NEVADA
Entity Type:Organization
Organization Name:DIVINE CARE SERVICES OF NEVADA
Other - Org Name:DIVINE CARE ORGANIZATION
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-689-0133
Mailing Address - Street 1:931 W OWENS AVE
Mailing Address - Street 2:STE. 150
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-2543
Mailing Address - Country:US
Mailing Address - Phone:702-542-0543
Mailing Address - Fax:
Practice Address - Street 1:931 W OWENS AVE
Practice Address - Street 2:STE. 150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2543
Practice Address - Country:US
Practice Address - Phone:702-542-0543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management