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Organization
DIVINE SAVIOR HEALTHCARE, INC.
Active
Organization
DIVINE SAVIOR HEALTHCARE, INC.
Active
Parent organization
DIVINE SAVIOR HEALTHCARE, INC.
Other names
Divine Savior Healthcare Pharmacy, Long Term Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
DIVINE SAVIOR HEALTHCARE, INC.
Authorized official
MR. MARLIN D NELSON (CFO)
(608) 745-5610
Entity
Organization
Contact information
Practice address
2817 NEW PINERY ROAD, PORTAGE, WI 53901
(608) 745-5603
(608) 742-6098
Mailing address
2817 NEW PINERY ROAD, PORTAGE, WI 53901
(608) 745-5603
(608) 742-6098
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33113100
—
WI
Enumeration date
03/21/2018
Last updated
03/21/2018
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