Healthcare Provider Details

I. General information

NPI: 1497610612
Provider Name (Legal Business Name): DIVINE GATE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8609 PARK VIEW BLVD
LA VISTA NE
68128-2024
US

IV. Provider business mailing address

8609 PARK VIEW BLVD
LA VISTA NE
68128-2024
US

V. Phone/Fax

Practice location:
  • Phone: 402-285-4480
  • Fax:
Mailing address:
  • Phone: 402-285-4480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: MR. OLA OLUDIPE
Title or Position: OWNER
Credential:
Phone: 402-285-4480