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General NPI Number Information
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NPI Number | 1417729237
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Entity Type | Organization
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Legal Business Name | DIVINE ANGELS HEALTHCARE SERVICES
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Dates
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Enumeration Date | 10/25/2023
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 1444 4TH ST
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City | DES MOINES
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State | IA
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Zip | 50314-3210
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Country | US
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Telephone | 412-334-1197
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Fax |
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Provider Business Mailing Address
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Address Line | 1444 4TH ST
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City | DES MOINES
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State | IA
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Zip | 50314-3210
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH
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Name | NIBITANGA NIBITANGA
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Credential |
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Telephone | 515-822-7449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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