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General NPI Number Information
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NPI Number | 1114622099
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Entity Type | Organization
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Legal Business Name | DIVINE GUARDIAN HEALTH ASSOCIATION
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Dates
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Enumeration Date | 03/31/2023
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Last Update Date | 05/17/2023
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Provider Practice Location Address
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Address Line | 485C US HIGHWAY 1 S STE 100-24
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City | ISELIN
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State | NJ
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Zip | 08830-3037
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Country | US
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Telephone | 914-514-0009
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Fax |
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Provider Business Mailing Address
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Address Line | 485C US HIGHWAY 1 S STE 100-24
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City | ISELIN
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State | NJ
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Zip | 08830-3037
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Country | US
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Telephone | 914-514-0009
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JODIAN WALTERS
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Credential |
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Telephone | 914-514-0009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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