Healthcare Provider Details

I. General information

NPI: 1407153281
Provider Name (Legal Business Name): DIVINE CARE MEDICALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2011
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 W URAL DR
CARLSBAD NM
88220-4059
US

IV. Provider business mailing address

1102 W URAL DR
CARLSBAD NM
88220-4059
US

V. Phone/Fax

Practice location:
  • Phone: 575-499-6916
  • Fax:
Mailing address:
  • Phone: 575-499-6916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTIAN CHINEDU NWOSU
Title or Position: DIRECTOR
Credential:
Phone: 575-499-6916