Healthcare Provider Details

I. General information

NPI: 1205276706
Provider Name (Legal Business Name): DIVINE INTERVENTIONS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 N FRANCES ST UNIT 17
SOUTH BEND IN
46617-2321
US

IV. Provider business mailing address

PO BOX 1894
ELKHART IN
46515-1894
US

V. Phone/Fax

Practice location:
  • Phone: 574-350-5292
  • Fax: 574-522-9846
Mailing address:
  • Phone: 574-350-5292
  • Fax: 574-522-9846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number13-013251
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number3430456059
License Number StateIN

VIII. Authorized Official

Name: MRS. NIKITA J BUTLER
Title or Position: PRESIDENT
Credential: BA
Phone: 574-350-5292