Healthcare Provider Details

I. General information

NPI: 1578628632
Provider Name (Legal Business Name): DIVINE HOME CARE OF OHIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 N CABLE RD
LIMA OH
45805-1704
US

IV. Provider business mailing address

904 N CABLE RD
LIMA OH
45805-1704
US

V. Phone/Fax

Practice location:
  • Phone: 419-222-9410
  • Fax: 419-222-6175
Mailing address:
  • Phone: 419-222-9410
  • Fax: 419-222-6175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. BABATUNDE ONAMUSI
Title or Position: PRESIDENT
Credential: MD
Phone: 419-222-9410