Provider Demographics
NPI:1477021467
Name:DIVINE COMFORT CARE HOSPICE INC
Entity Type:Organization
Organization Name:DIVINE COMFORT CARE HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/ALTNATE ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARYLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:832-646-5784
Mailing Address - Street 1:7324 SOUTHWEST FWY STE 620
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7324 SOUTHWEST FWY STE 620
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2003
Practice Address - Country:US
Practice Address - Phone:832-897-7359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid