Healthcare Provider Details

I. General information

NPI: 1245969245
Provider Name (Legal Business Name): DEVINE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10240 N 31ST AVE STE 122
PHOENIX AZ
85051-9564
US

IV. Provider business mailing address

10240 N 31ST AVE STE 122
PHOENIX AZ
85051-9564
US

V. Phone/Fax

Practice location:
  • Phone: 623-330-6269
  • Fax:
Mailing address:
  • Phone: 623-330-6269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DAVID ORIABURE
Title or Position: ADMINISTRATOR
Credential:
Phone: 623-330-6269