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General NPI Number Information
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NPI Number | 1144671355
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Entity Type | Organization
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Legal Business Name | DIVINE LOVE OUTREACH MINISTRIES
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Dates
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Enumeration Date | 06/29/2016
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Last Update Date | 06/29/2016
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Provider Practice Location Address
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Address Line | 500 N F ST
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City | MUSKOGEE
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State | OK
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Zip | 74403-4144
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Country | US
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Telephone | 918-360-2843
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Fax |
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Provider Business Mailing Address
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Address Line | 500 N F ST
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City | MUSKOGEE
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State | OK
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Zip | 74403-4144
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Country | US
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Telephone | 918-360-2843
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/OWNER
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Name | MICHAEL WEBBER SR.
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Credential |
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Telephone | 918-403-8404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training 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 | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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