Divine Grace Hospice, Inc

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

DIVINE GRACE HOSPICE, INC

Practice address

4766 Park Granada Ste 106
Calabasas, CA 91302-3384

Phone

(626) 261-4565

Fax

(626) 261-4561

NPI assigned

Nov 14, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Christopher Hendry

Title

Administrator Designee

Phone

(818) 781-8111

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Hospice certification: CCN A01543

Legal name

DIVINE GRACE HOSPICE, INC.

Certification status

Active

Provider type (POS)

Hospice

Participating since

Jul 27, 2018

Last certification

Jul 27, 2018

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

in CA

Enrollment address

4766 Park Granada
Ste 112
Calabasas, CA 91302-3347

Listed as

Divine Grace Hospice, IncCCN A01543 · All quality measures

Ownership

For-Profit

Certified

Jul 27, 2018

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Borna Solomon, M.D.

  • Internal Medicine Physician
  • Mission Hills, CA
  • NPI 1124300082

  5% Or Greater Direct Ownership Interest, Corporate Director

  CMS ownership

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Borna Solomon, M.D.

  • Internal Medicine Physician
  • Mission Hills, CA
  • NPI 1124300082
  NPD

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Borna Solomon, M.D.

  • Internal Medicine Physician
  • Mission Hills, CA
  • NPI 1124300082

  Hospice

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1384387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660521600000",
    "number": "1033549936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4766 PARK GRANADA STE 106",
            "city": "CALABASAS",
            "state": "CA",
            "postal_code": "913023384",
            "telephone_number": "626-261-4565",
            "fax_number": "626-261-4561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4766 PARK GRANADA STE 106",
            "city": "CALABASAS",
            "state": "CA",
            "postal_code": "913023384",
            "telephone_number": "626-261-4565",
            "fax_number": "626-261-4561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE GRACE HOSPICE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-14",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "status": "A",
        "authorized_official_last_name": "HENDRY",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "ADMINISTRATOR DESIGNEE",
        "authorized_official_telephone_number": "818-781-8111"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Laurel Deurmier
• Craig Harry Diamond, D.C.
• Natasha Diaz, LMFT
• Nicole Dockery, DDS
• Robin D Domino, CRNA
• Dr Pharmacy RX Inc (Dr Pharmacy RX)
• Dr. Matthew Alpert O.D. and Dr. Joshua Corben O.D., Optometric Corpora (Wink Optometry)
• Randi S Drasin, MS, RDN

• Community Based Hospice Care Agency in Calabasas, CA
• Providers in Calabasas, CA by specialty
• Community Based Hospice Care Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.