Healthcare Provider Details

I. General information

NPI: 1700730744
Provider Name (Legal Business Name): DIVINE SOLUTIONS HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5497 28TH AVE S APT 2013
FARGO ND
58104-9045
US

IV. Provider business mailing address

5497 28TH AVE S APT 2013
FARGO ND
58104-9045
US

V. Phone/Fax

Practice location:
  • Phone: 614-571-2711
  • Fax:
Mailing address:
  • Phone: 614-571-2711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER T FALLAH SR.
Title or Position: CEO/OWNER
Credential:
Phone: 614-571-2711