NPIMap

Organization Active NPI

Divine Intervention Healthcare, Inc

  • Community Based Hospice Care Agency
  • Matteson, IL
National Provider Identifier
1427302041
Registry record updated Nov 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
2003090 Issued in IL
Legal business name
DIVINE INTERVENTION HEALTHCARE, INC
Practice address
4747 Lincoln Mall Dr
Suite 502
Matteson, IL 60443-3811
Phone
(708) 248-7662
Fax
(708) 248-7682
NPI assigned
Nov 5, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2012

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

Authorized official

Name
Mrs. Sandrena A Harris, RN
Title
Director of Nursing
Phone
(708) 248-7662

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 2003090 IL Primary

Addresses

Primary practice location

4747 Lincoln Mall Dr
Suite 502
Matteson, IL 60443-3811

Mailing address

4747 Lincoln Mall Dr
Suite 502
Matteson, IL 60443-3811
Phone (708) 248-7662

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1352073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352073600000",
    "number": "1427302041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4747 LINCOLN MALL DR",
            "address_2": "SUITE 502",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604433811",
            "telephone_number": "708-248-7662",
            "fax_number": "708-248-7682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4747 LINCOLN MALL DR",
            "address_2": "SUITE 502",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604433811",
            "telephone_number": "708-248-7662",
            "fax_number": "708-248-7682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE INTERVENTION HEALTHCARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-05",
        "last_updated": "2012-11-05",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "SANDRENA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR OF NURSING",
        "authorized_official_telephone_number": "708-248-7662",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "IL",
            "license": "2003090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Matteson, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2012; 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.