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General NPI Number Information
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NPI Number | 1326546508
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Entity Type | Organization
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Legal Business Name | DIVINE CARE INC.
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Dates
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Enumeration Date | 01/23/2018
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Last Update Date | 01/23/2018
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Provider Practice Location Address
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Address Line | 12401 BRICKYARD BLVD APT 1108
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City | BELTSVILLE
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State | MD
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Zip | 20705-1356
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Country | US
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Telephone | 609-634-2093
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Fax | 609-634-2093
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Provider Business Mailing Address
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Address Line | 17 MULBERRY ST
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City | SICKLERVILLE
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State | NJ
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Zip | 08081-1600
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Country | US
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Telephone | 609-634-2093
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | PAUL NWOGA
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Credential |
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Telephone | 609-634-2093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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