Healthcare Provider Details

I. General information

NPI: 1093059321
Provider Name (Legal Business Name): DIVINE HEALTH CARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2012
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6315 SEABROOK RD SUITE 107
LANHAM MD
20706-2628
US

IV. Provider business mailing address

6315 SEABROOK RD SUITE 107
LANHAM MD
20706-2628
US

V. Phone/Fax

Practice location:
  • Phone: 301-257-7575
  • Fax: 301-358-3803
Mailing address:
  • Phone: 301-257-7575
  • Fax: 301-358-3803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberNSA-0320
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberR2628R
License Number StateMD

VIII. Authorized Official

Name: MR. HAMID STANLEY CONTEH
Title or Position: ADMINISTRATOR
Credential:
Phone: 301-257-7575