MEDICARE: DIVINE ORACLE COMMUNITY HEALTH INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251C00000X	Developmentally Disabled Services Day Training Agency
3	251E00000X	Home Health Agency
4	251G00000X	Community Based Hospice Care Agency
5	251J00000X	Nursing Care Agency
6	251K00000X	Public Health or Welfare Agency
7	251S00000X	Community/Behavioral Health Agency
8	253Z00000X	In Home Supportive Care Agency
9	261QA0600X	Adult Day Care Clinic/Center
10	261QC1500X	Community Health Clinic/Center
11	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
12	261QP2000X	Physical Therapy Clinic/Center
13	310400000X	Assisted Living Facility
14	3104A0625X	Assisted Living Facility (Mental Illness)
15	261QD1600X	Developmental Disabilities Clinic/Center

General Provider Information

NPI Number	:	1538938428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE ORACLE COMMUNITY HEALTH INC.

Provider Business Mailing Address
First Line	:	5872 EASTERN AVE NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-2721
Country	:	US
Telephone Number	:	202-368-2456
Fax Number	:

Provider Business Practice Location Address
First Line	:	5872 EASTERN AVE NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-2721
Country	:	US
Telephone Number	:	202-368-2456
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DOMINIQUE MBACHIE
Credential	:	RN
Telephone Number	:	202-368-2456

Provider Enumeration Date	:	12/20/2023
Last Update Date	:	12/20/2023

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