Provider Demographics
NPI:1376978833
Name:DIVINE MERCY SUPPORTIVE CARE
Entity Type:Organization
Organization Name:DIVINE MERCY SUPPORTIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-357-2540
Mailing Address - Street 1:303 S BROADWAY
Mailing Address - Street 2:#220
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-1558
Mailing Address - Country:US
Mailing Address - Phone:303-357-2540
Mailing Address - Fax:
Practice Address - Street 1:4045 PECOS ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-2552
Practice Address - Country:US
Practice Address - Phone:303-357-2540
Practice Address - Fax:720-398-3490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-03
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17M599251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17M599OtherSTATE OF COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
CO17M599OtherSTATE OF COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT