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General NPI Number Information
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NPI Number | 1508982489
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Entity Type | Organization
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Legal Business Name | DIVINE FAMILY CARE HOME INC.
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 01/04/2008
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Provider Practice Location Address
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Address Line | 306 LUMPKIN BLVD FRANKLIN COUNTY
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City | LOUISBURG
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State | NC
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Zip | 27549-2143
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Country | US
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Telephone | 919-729-3134
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Fax | 919-729-3134
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Provider Business Mailing Address
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Address Line | 306 LUMPKIN BLVD FRANKLIN COUNTY
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City | LOUISBURG
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State | NC
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Zip | 27549-2143
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Country | US
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Telephone | 919-729-3134
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Fax | 919-729-3134
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Authorized Official
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Title or Position | OWNER
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Name | MR. CHRIS O. ISIJOLA
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Credential |
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Telephone | 919-880-4619
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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 | FCL-035-016
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License Number State | NC
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