Provider Demographics
NPI:1730582941
Name:DIVINE MERCY HEALTH SERVICES LLC
Entity type:Organization
Organization Name:DIVINE MERCY HEALTH SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DELSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAGALEA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:702-202-0763
Mailing Address - Street 1:3750 S JONES BLVD
Mailing Address - Street 2:STE 130
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-2208
Mailing Address - Country:US
Mailing Address - Phone:702-202-0763
Mailing Address - Fax:702-202-1293
Practice Address - Street 1:1641 E FLAMINGO RD STE 8
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5257
Practice Address - Country:US
Practice Address - Phone:702-202-0763
Practice Address - Fax:702-202-1293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based