Provider Demographics
NPI:1760556864
Name:DEVINE HEALTHCARE SERVICE, INC.
Entity Type:Organization
Organization Name:DEVINE HEALTHCARE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:DEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:574-255-4545
Mailing Address - Street 1:PO BOX 17
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46546-0017
Mailing Address - Country:US
Mailing Address - Phone:574-255-4545
Mailing Address - Fax:574-255-7664
Practice Address - Street 1:2222 HOMEWOOD AVE
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-3336
Practice Address - Country:US
Practice Address - Phone:574-255-4545
Practice Address - Fax:574-255-7664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty