Healthcare Provider Details

I. General information

NPI: 1467759779
Provider Name (Legal Business Name): DIVINE PROMISES NURSING AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2011
Last Update Date: 02/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 WALLY WAY
EL CAJON CA
92021-3684
US

IV. Provider business mailing address

1630 WALLY WAY
EL CAJON CA
92021-3684
US

V. Phone/Fax

Practice location:
  • Phone: 619-334-3438
  • Fax: 619-334-3438
Mailing address:
  • Phone: 619-334-3438
  • Fax: 619-334-3438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. TITILOLA HARRIET ADANRITAYLOR
Title or Position: PRESIDENT/CEO
Credential:
Phone: 619-334-3438