Provider Demographics
NPI:1336457324
Name:DIVINE HOSPICE LLC
Entity Type:Organization
Organization Name:DIVINE HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FIDEL
Authorized Official - Middle Name:RAMOS
Authorized Official - Last Name:NAVATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-242-4663
Mailing Address - Street 1:5000 W OAKEY BLVD STE A7
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-3394
Mailing Address - Country:US
Mailing Address - Phone:702-242-4663
Mailing Address - Fax:702-242-4662
Practice Address - Street 1:5000 W OAKEY BLVD STE A7
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3394
Practice Address - Country:US
Practice Address - Phone:702-242-4663
Practice Address - Fax:702-242-4662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1010126172-001251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based