# DIVINE SAVIOR HEALTHCARE, INC.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** DIVINE SAVIOR HEALTHCARE, INC.
- **Other names:** Divine Savior Healthcare Pharmacy, Long Term Care
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1831693100
- **Legal business name:** DIVINE SAVIOR HEALTHCARE, INC.
- **Authorized official:** MR. MARLIN D NELSON (CFO)
- **Authorized official phone:** (608) 745-5610

## Contact information

- **Practice address:** 2817 NEW PINERY ROAD, PORTAGE, WI 53901
- **Practice address phone:** (608) 745-5603
- **Practice address fax:** (608) 742-6098
- **Mailing address:** 2817 NEW PINERY ROAD, PORTAGE, WI 53901
- **Mailing address phone:** (608) 745-5603
- **Mailing address fax:** (608) 742-6098

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | — | WI | Yes |

## Other

- **Enumeration date:** 03/21/2018
- **Last updated:** 03/21/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 33113100 | — | WI |