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General NPI Number Information
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NPI Number | 1346115862
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Entity Type | Organization
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Legal Business Name | DIVINE HAVEN LLC
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 106 CRYSTAL LN
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City | MADISON
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State | WI
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Zip | 53714-2505
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Country | US
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Telephone | 608-320-8259
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Fax |
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Provider Business Mailing Address
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Address Line | 106 CRYSTAL LN
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City | MADISON
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State | WI
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Zip | 53714-2505
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Country | US
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Telephone | 608-320-8259
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | OLAYINKA AFOLABI
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Credential |
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Telephone | 608-320-8259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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