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General NPI Number Information
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NPI Number | 1235892159
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Entity Type | Organization
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Legal Business Name | DIVINE PERSONAL CARE AGENCY
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Dates
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Enumeration Date | 10/18/2021
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Last Update Date | 10/18/2021
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Provider Practice Location Address
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Address Line | 8330 N TEUTONIA AVE STE 200
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City | BROWN DEER
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State | WI
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Zip | 53209-1550
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Country | US
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Telephone | 414-236-5608
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Fax | 414-236-5632
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Provider Business Mailing Address
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Address Line | 8330 N TEUTONIA AVE STE 200
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City | BROWN DEER
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State | WI
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Zip | 53209-1550
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Country | US
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Telephone | 414-236-5608
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Fax | 414-236-5632
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Authorized Official
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Title or Position | OWNER
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Name | MELISSA A SLOAN
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Credential |
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Telephone | 414-232-3962
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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