Healthcare Provider Details

I. General information

NPI: 1629535620
Provider Name (Legal Business Name): DIVINE-POINT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 GREENFIELD RD
DEARBORN MI
48120-1802
US

IV. Provider business mailing address

3200 GREENFIELD RD
DEARBORN MI
48120-1802
US

V. Phone/Fax

Practice location:
  • Phone: 586-422-8486
  • Fax: 313-915-4458
Mailing address:
  • Phone: 586-422-8486
  • Fax: 313-915-4458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: INNOCENT NDUKWE
Title or Position: OWNER
Credential:
Phone: 586-422-8486