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General NPI Number Information
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NPI Number | 1508365032
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Entity Type | Organization
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Legal Business Name | DIVINE COMPANION CARE SERVICES
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Dates
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Enumeration Date | 02/10/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 616 MCDONALD AVE
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City | RUSTON
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State | LA
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Zip | 71270-4627
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Country | US
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Telephone | 318-243-1743
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Fax |
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Provider Business Mailing Address
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Address Line | 616 MCDONALD AVE
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City | RUSTON
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State | LA
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Zip | 71270-4627
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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 | OWNER
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Name | MS. MARKEDRA LYNNELL WHEATLEY
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Credential |
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Telephone | 318-243-1743
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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