Healthcare Provider Details

I. General information

NPI: 1922252709
Provider Name (Legal Business Name): DIVINE HEALTH CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9470 ANNAPOLIS RD SUITE 413
LANHAM MD
20706-3025
US

IV. Provider business mailing address

9470 ANNAPOLIS RD SUITE 413
LANHAM MD
20706-3025
US

V. Phone/Fax

Practice location:
  • Phone: 301-459-2583
  • Fax:
Mailing address:
  • Phone: 301-459-2583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberR2628
License Number StateMD

VIII. Authorized Official

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