Healthcare Provider Details

I. General information

NPI: 1053615039
Provider Name (Legal Business Name): DIVINE PROMISES NURSING AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 01/05/2011
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 Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number643553
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number643553
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number643553
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number643553
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number643553
License Number StateCA
# 10
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number643553
License Number StateCA
# 11
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number643553
License Number StateCA
# 12
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number643553
License Number StateCA
# 13
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number643553
License Number StateCA
# 14
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

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