Divine Hospice Inc

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

008914 Issued in TX

Legal business name

DIVINE HOSPICE INC

Practice address

345 Westpark Way
#101
Euless, TX 76040-3913

Phone

(817) 268-1946

Fax

(817) 268-0209

NPI assigned

Jun 17, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Consolota Bryant, RN

Title

Administrator

Phone

(817) 268-1946

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Professional Hospice Other name

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Hospice certification: CCN 451764

Legal name

DIVINE HOSPICE INC

Doing business as

PROFESSIONAL HOSPICE

Certification status

Active

Provider type (POS)

Hospice

Participating since

Aug 13, 2004

Last certification

Feb 14, 2022

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Sep 5, 2003 in TX

Enrollment address

345 West Parkway
Suite 101
Euless, TX 76040-3936

Listed as

Professional HospiceCCN 451764

Ownership

For-Profit

Certified

Aug 13, 2004

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

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.

• Elmer G Smith Jr., MD

  • Internal Medicine Physician
  • Bedford, TX
  • NPI 1699793992

  Contracted Managing Employee, Corporate Director

  CMS ownership

Affiliated clinicians 1

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

• Elmer G Smith Jr., MD

  • Internal Medicine Physician
  • Bedford, TX
  • NPI 1699793992

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581552000000",
    "number": "1285679118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 WESTPARK WAY",
            "address_2": "#101",
            "city": "EULESS",
            "state": "TX",
            "postal_code": "760403913",
            "telephone_number": "817-268-1946",
            "fax_number": "817-268-0722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 WESTPARK WAY",
            "address_2": "#101",
            "city": "EULESS",
            "state": "TX",
            "postal_code": "760403913",
            "telephone_number": "817-268-1946",
            "fax_number": "817-268-0209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE HOSPICE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-17",
        "last_updated": "2020-02-13",
        "certification_date": "2020-02-13",
        "status": "A",
        "authorized_official_last_name": "BRYANT",
        "authorized_official_first_name": "CONSOLOTA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "817-268-1946",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "TX",
            "license": "008914",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001012721",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Professional Hospice",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Professional Hospice",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Community Based Hospice Care Agency in Euless, TX
• Providers in Euless, TX by specialty
• Community Based Hospice Care Agency in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2020; 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.