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General NPI Number Information
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NPI Number | 1225290430
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Entity Type | Organization
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Legal Business Name | DIVINE HEALTHCARE SERVICES, LLC.
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Dates
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Enumeration Date | 06/28/2008
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 60 EVERGREEN PL STE 501
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City | EAST ORANGE
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State | NJ
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Zip | 07018-2118
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Country | US
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Telephone | 973-900-0110
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Fax | 973-900-0110
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Provider Business Mailing Address
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Address Line | 60 EVERGREEN PL STE 501
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City | EAST ORANGE
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State | NJ
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Zip | 07018-2118
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Country | US
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Telephone | 973-900-0110
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Fax | 973-900-0110
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. STELLA F. OBIDIGBO
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Credential |
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Telephone | 973-996-2270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 26N012346500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 26N012346500
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License Number State | NJ
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