Healthcare Provider Details

I. General information

NPI: 1942504121
Provider Name (Legal Business Name): DIVINE PROMISES NURSING AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 01/03/2011
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 TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number643553
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number643553
License Number StateCA
# 7
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

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