Provider Demographics
NPI:1053417683
Name:DIVINE DEDICATION INC
Entity type:Organization
Organization Name:DIVINE DEDICATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-751-7077
Mailing Address - Street 1:12510 EAST ILIFF
Mailing Address - Street 2:STE 115
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-6377
Mailing Address - Country:US
Mailing Address - Phone:303-751-7077
Mailing Address - Fax:303-751-7009
Practice Address - Street 1:12510 EAST ILIFF
Practice Address - Street 2:STE 115
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-6377
Practice Address - Country:US
Practice Address - Phone:303-751-7077
Practice Address - Fax:303-751-7009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO251E00000X
CO68525761251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO68525761Medicaid
CO68525761Medicaid