Divine Light Hospice LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

DIVINE LIGHT HOSPICE LLC

Practice address

5750 Brook Hollow Pkwy Ste 104
Norcross, GA 30071-3515

Phone

(770) 696-1703

Fax

(470) 226-3371

NPI assigned

Nov 4, 2021

Organization subpart

No

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

Authorized official

Name

Mrs. Alissa R Boston, RN

Title

Owner

Phone

(770) 696-1703

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Hospice certification: CCN 851559

Legal name

DIVINE LIGHT HOSPICE LLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Sep 21, 2022

Last certification

Sep 21, 2022

Ownership / control type

Proprietary - Partnership

Organization structure

LLCProprietary

Incorporated

Dec 2, 2020 in GA

Enrollment address

5750 Brook Hollow Pkwy
Ste 104
Norcross, GA 30071-3515

Listed as

Divine Light HospiceCCN 851559

Certified

Sep 21, 2022

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 3

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

Affiliated clinicians 1

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

• Lee Wilkes, MD

  • Internal Medicine Physician
  • Tucker, GA
  • NPI 1568441871

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1635984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635984000000",
    "number": "1326703232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5750 BROOK HOLLOW PKWY STE 104",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300713515",
            "telephone_number": "770-696-1703",
            "fax_number": "470-226-3371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5750 BROOK HOLLOW PKWY STE 104",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300713515",
            "telephone_number": "770-696-1703",
            "fax_number": "470-226-3371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE LIGHT HOSPICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-04",
        "last_updated": "2021-11-04",
        "certification_date": "2021-11-04",
        "status": "A",
        "authorized_official_last_name": "BOSTON",
        "authorized_official_first_name": "ALISSA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-696-1703",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hannah Dinh
• To Nga Thi Dinh, D.M.D.
• Tene Emma Laeticia Dioma, MS
• Alana M Dison
• Divine Dentistry LLC
• DME Station
• Quynh CHI N DO, DOCTOR OF PHARMACY
• Heman B Dodani, M.D.
• Allison Ballay Donnelly, CCC-SLP
• Cass Nelson Dooley, MS

• Community Based Hospice Care Agency in Norcross, GA
• Providers in Norcross, GA by specialty
• Community Based Hospice Care Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2021; 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.