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General NPI Number Information
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NPI Number | 1376149468
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Entity Type | Organization
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Legal Business Name | DIVINE LIGHT HOMECARE LLC
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Dates
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Enumeration Date | 12/05/2020
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Last Update Date | 12/05/2020
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Provider Practice Location Address
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Address Line | 875 N MICHIGAN AVE # 3178
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City | CHICAGO
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State | IL
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Zip | 60611-1803
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Country | US
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Telephone | 224-488-0600
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Fax | 847-789-9728
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Provider Business Mailing Address
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Address Line | 71 NICHOLAS DR W
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City | DES PLAINES
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State | IL
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Zip | 60016-6221
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Country | US
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Telephone | 312-792-6477
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Fax | 847-789-9728
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Authorized Official
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Title or Position | PRESIDENT/AGENCY MANAGER
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Name | MRS. IMOLEAYO MARY OLUYEDE
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Credential |
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Telephone | 312-792-6477
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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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