Healthcare Provider Details

I. General information

NPI: 1225290430
Provider Name (Legal Business Name): DIVINE HEALTHCARE SERVICES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2008
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 EVERGREEN PL STE 501
EAST ORANGE NJ
07018-2118
US

IV. Provider business mailing address

60 EVERGREEN PL STE 501
EAST ORANGE NJ
07018-2118
US

V. Phone/Fax

Practice location:
  • Phone: 973-900-0110
  • Fax: 973-900-0110
Mailing address:
  • Phone: 973-900-0110
  • Fax: 973-900-0110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number26N012346500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number26N012346500
License Number StateNJ

VIII. Authorized Official

Name: MS. STELLA F. OBIDIGBO
Title or Position: DIRECTOR
Credential:
Phone: 973-996-2270