DIVINE SAVIOR HEALTHCARE, INC. (NPI# 1831693100) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831693100 |
| Entity Type | Organization |
| Organization Name | DIVINE SAVIOR HEALTHCARE, INC. |
| Other Organization Name | DIVINE SAVIOR HEALTHCARE PHARMACY, LONG TERM CARE |
| Practice Address |
2817 New Pinery Road Portage WI 53901 |
| Practice Telephone | 6087455603 |
| Practice Fax Number | 6087426098 |
| Mailing Telephone | 6087455603 |
| Mailing Fax Number | 6087426098 |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2018-03-21 |
| Authorized Official Name | MR. MARLIN D NELSON (CFO) |
| Authorized Official Telephone | 6087455610 |
| Is Organization Subpart | Y |
| Parent Organization Name | DIVINE SAVIOR HEALTHCARE, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
WI | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 33113100 | 05 |
| Other Name | Type Code |
|---|---|
| Divine Savior Healthcare Pharmacy, Long Term Care | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942712344 | Divine Savior Healthcare, Inc. | Clinic/Center | N4390 Crossroads Clinic Road, Oxford, WI 53952 | 2017-10-26 |
| 1861904294 | Divine Savior Healthcare, Inc. | Clinic/Center | 102 Gillette Street, Pardeeville, WI 53954 | 2017-10-25 |
| 1386154417 | Divine Savior Healthcare, Inc. | Clinic/Center | 2817 New Pinery Road, Portage, WI 53901-0387 | 2017-10-03 |
| 1710133095 | Divine Savior Healthcare, Inc. | Pharmacy | 2817 New Pinery Rd, Portage, WI 53901-9257 | 2008-08-18 |
| 1124083894 | Divine Savior Healthcare, Inc. | General Acute Care Hospital | 2817 New Pinery Rd, Portage, WI 53901-0387 | 2006-04-18 |
| Street Address |
2817 NEW PINERY ROAD |
| City | PORTAGE |
| State | WI |
| Zip Code | 53901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265428841 | Robert Vincent Castrovinci | Ophthalmology | 2817 New Pinery Road, Portage, WI 53901-0387 | 2005-09-20 |
| 1386154417 | Divine Savior Healthcare, Inc. | Clinic/Center | 2817 New Pinery Road, Portage, WI 53901-0387 | 2017-10-03 |
| 1386160125 | Diana L Charlebois | Nurse Practitioner | 2817 New Pinery Road, Portage, WI 53901 | 2017-08-14 |
| 1851537245 | Aimee Stieve | Physical Therapist | 2817 New Pinery Road, Divine Savior Healthcare, Portage, WI 53901-0387 | 2009-01-06 |
| 1255508255 | Lori A Schumann | Physical Therapist | 2817 New Pinery Road, Divine Savior Healthcare, Portage, WI 53901-0387 | 2008-05-09 |
| 1467644195 | James M Swan Jr. | Nurse Practitioner | 2817 New Pinery Road, Divine Savior Healthcare Inc, Portage, WI 53901-0387 | 2007-08-16 |
| 1316147408 | Divine Savior Healthcare Inc | Medicare Defined Swing Bed Unit | 2817 New Pinery Road, Divine Savior Healthcare Inc, Portage, WI 53901-0387 | 2007-07-18 |
| 1538177480 | Carol Ada Pierce | Surgery | 2817 New Pinery Road, Divine Savior Healthcare Inc, Portage, WI 53901 | 2006-08-04 |
| 1922037175 | Daniel R Langan | Nurse Anesthetist, Certified Registered | 2817 New Pinery Road, Divine Savior Healthcare Inc, Portage, WI 53901-0387 | 2006-07-01 |
| 1962442590 | Frank L. Walter | Orthopaedic Surgery | 2817 New Pinery Road, Portage, WI 53901-0387 | 2006-06-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740710748 | Robert James Corliss | Internal Medicine | St. Vincent Fmc, 140east Cook St., Portage, WI 53901 | 2017-06-13 |
| 1639328867 | Casey Jo Ambort | Speech-Language Pathologist | 626 East Slifer St, Portage, WI 53901 | 2008-09-11 |
| 1871767400 | Planned Parenthood of Wi, Inc | Non-Pharmacy Dispensing Site | 132 W. Cook St., Portage, WI 53901 | 2008-04-15 |
| 1881872158 | Marta Jean Jindra | Physical Therapist | 626 E Slifer Street, Portage, WI 53901 | 2008-02-08 |
| 1699953976 | Lana Marie Edwards | Speech-Language Pathologist | 626 East Slifer Street, Portage, WI 53901 | 2008-02-08 |
| 1134314552 | Kristina Hellenbrand | Physical Therapist | 2639 New Pinery Road, Suite 2, Portage, WI 53901 | 2007-09-10 |
| 1689727810 | Gregory Allan Bindl | Chiropractor | 2121new Pinery Rd, Portage, WI 53901 | 2007-01-19 |
| 1720149156 | Timothy J Rosin Dds Sc | Dentist | 2570 New Pinery Rd, Portage, WI 53901 | 2006-12-12 |
| 1710083779 | Currani Seubert Dental Office LLC | Dentist | 260 W Cook St, Portage, WI 53901 | 2006-09-16 |
| 1225090525 | University of Wisconsin Medical Foundation Inc | Durable Medical Equipment & Medical Supplies | 2977 Cty Hwy Cx, Portage, WI 53901 | 2006-04-04 |
| Find all providers in zip 53901 | ||||
| Taxonomy Code | 3336L0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Long Term Care Pharmacy |
| A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
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| 1962999805 | Guardian Pharmacy of Madison, LLC | Pharmacy | N85 W15882 Appleton Ave, Menomonee Falls, WI 53051-3082 | 2018-04-17 |
| 1164932091 | Mabie Pharmacy, LLC | Pharmacy | 10 Liberty St # 106, Deerfield, WI 53531-9458 | 2017-10-05 |
| 1487101754 | Evergreen Pharmacy LLC | Pharmacy | 10101 W Greenfield Ave, West Allis, WI 53214-3953 | 2016-09-05 |
| 1639548142 | Lynja Inc | Pharmacy | 3215 8th St S Ste 101, Wisconsin Rapids, WI 54494-6564 | 2015-09-15 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.