Divine Dedication Home

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

251E00000X Issued in CO

Legal business name

DIVINE DEDICATION HOME

Practice address

2851 S Parker Rd
#428
Aurora, CO 80014-2736

Phone

(303) 751-7077

NPI assigned

Jun 6, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Raquel L Martin

Title

Admin

Phone

(303) 751-7077

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463011200000",
    "number": "1073716494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2851 S PARKER RD STE 428",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800142802",
            "telephone_number": "303-751-7077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2851 S PARKER RD",
            "address_2": "#428",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800142736",
            "telephone_number": "303-751-7077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE DEDICATION HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-06",
        "last_updated": "2016-05-12",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "RAQUEL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ADMIN",
        "authorized_official_telephone_number": "303-751-7077",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "CO",
            "license": "251E00000X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "70283231",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Distefano, MD
• Carol Dittmann, M.D.
• Yazmin Ditzler
• Diversity Support Inc
• Divine Child Limited
• Divine Dedication Inc
• Divine Forever Care LLC
• Divine Health & Wellness, LLC
• Divine Interventions, LLC (Divine Interventions Agency)
• Divine Royal Care, LLC

• Preferred Provider Organization in Aurora, CO
• Providers in Aurora, CO by specialty
• Preferred Provider Organization in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.