Healthcare Provider Details

I. General information

NPI: 1154259695
Provider Name (Legal Business Name): DIVINE ARRIVAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 N CANTON CENTER RD STE 120
CANTON MI
48187-2679
US

IV. Provider business mailing address

22040 BECK RD
NORTHVILLE MI
48167-3322
US

V. Phone/Fax

Practice location:
  • Phone: 734-981-2800
  • Fax: 734-981-9028
Mailing address:
  • Phone: 734-981-2800
  • Fax: 734-981-9028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: JYOTHI NICHANAMETLA
Title or Position: DOCTOR
Credential: MD
Phone: 734-981-2800