Healthcare Provider Details

I. General information

NPI: 1932583879
Provider Name (Legal Business Name): DIVINE NURSE CONSULTANT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 OAK POND RD
ROCK HILL SC
29730-7958
US

IV. Provider business mailing address

2210 OAK POND RD
ROCK HILL SC
29730-7958
US

V. Phone/Fax

Practice location:
  • Phone: 803-329-4494
  • Fax: 803-329-5902
Mailing address:
  • Phone: 803-329-4494
  • Fax: 803-329-5902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberRC1361
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License NumberRC1361
License Number StateSC

VIII. Authorized Official

Name: DR. CLIFFORD C AFAM
Title or Position: DIRECTOR
Credential:
Phone: 980-622-8530