Healthcare Provider Details

I. General information

NPI: 1538556477
Provider Name (Legal Business Name): DIVINE ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 ARLINGTON RD N
JACKSONVILLE FL
32211-5811
US

IV. Provider business mailing address

11403 KABROON CT
JACKSONVILLE FL
32246-6918
US

V. Phone/Fax

Practice location:
  • Phone: 904-586-7611
  • Fax:
Mailing address:
  • Phone: 904-586-7611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MOJISOLA O ABIDOGUN
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 904-586-7611