| Devine Nutrition Inc | |
|
6811 167th St Ste 6 Tinley Park IL 60477-2501 | |
| (708) 612-0876 | |
| Not Available |
| Full Name | Devine Nutrition Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6811 167th St Ste 6, Tinley Park, Illinois |
| Authorized Official Name and Position | Kelly L Devine (PRESIDENT) |
| Authorized Official Contact | 7086120876 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Devine Nutrition Inc 6521 Charleston St Oak Forest IL 60452-2626 Ph: (708) 612-0876 | Devine Nutrition Inc 6811 167th St Ste 6 Tinley Park IL 60477-2501 Ph: (708) 612-0876 |
| NPI Number | 1982012241 |
|---|---|
| Provider Enumeration Date | 07/30/2014 |
| Last Update Date | 03/04/2024 |
| Medicare PECOS PAC ID | 7214297936 |
|---|---|
| Medicare Enrollment ID | O20240604002937 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982012241 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 164004722 (Illinois) | Primary |
| Provider Name | Kelly L Devine Rickert |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1003001405 PECOS PAC ID: 2062502941 Enrollment ID: I20240604002799 |
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