Healthcare Provider Details

I. General information

NPI: 1598402646
Provider Name (Legal Business Name): PN DIVINE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 SEARINGTOWN RD
ALBERTSON NY
11507-1537
US

IV. Provider business mailing address

24 DRYDEN WAY
COMMACK NY
11725-1928
US

V. Phone/Fax

Practice location:
  • Phone: 516-348-3574
  • Fax:
Mailing address:
  • Phone: 516-348-3574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PARIMDER KAUR
Title or Position: PRESIDENT
Credential:
Phone: 516-348-3574