| Organization Name: | DIVINE HOSPICE LLC |
| NPI Number: | 1336457324 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | FIDEL RAMOS NAVATA (CEO) |
| Mailing Address: | 5000 W Oakey Blvd Ste A7 Las Vegas |
| State: | NV US |
| Postal Code: | 891463394 |
| Phone Number: | 7022424663 |
| Fax Number: | 7022424662 |
| NPI Enumeration Date: | 09/23/2010 |
| NPI Last Update Date: | 09/23/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251G00000X |
| License Number: | 1010126172-001 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NV |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Hospice Care, Community Based |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |