Provider Demographics
NPI:1831635390
Name:DEVINE HEALTHCARE, LLC
Entity Type:Organization
Organization Name:DEVINE HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:402-382-3555
Mailing Address - Street 1:843 E 4TH ST, STE A
Mailing Address - Street 2:
Mailing Address - City:AINSWORTH
Mailing Address - State:NE
Mailing Address - Zip Code:69210-1207
Mailing Address - Country:US
Mailing Address - Phone:402-382-3555
Mailing Address - Fax:
Practice Address - Street 1:843 E 4TH ST STE A
Practice Address - Street 2:
Practice Address - City:AINSWORTH
Practice Address - State:NE
Practice Address - Zip Code:69210
Practice Address - Country:US
Practice Address - Phone:402-382-3555
Practice Address - Fax:402-382-3556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111402261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NA1943013Medicare PIN