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General NPI Number Information
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NPI Number | 1528556453
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Entity Type | Organization
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Legal Business Name | DIVINECARELLC
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Dates
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Enumeration Date | 04/26/2018
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Last Update Date | 04/26/2018
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Provider Practice Location Address
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Address Line | 16926 SW STEELE WAY
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City | BEAVERTON
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State | OR
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Zip | 97006-8936
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Country | US
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Telephone | 971-222-9122
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Fax |
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Provider Business Mailing Address
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Address Line | 16926 SW STEELE WAY
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City | BEAVERTON
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State | OR
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Zip | 97006-8936
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Country | US
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Telephone | 971-222-9122
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | REGINA E ORIKANNU SIMON
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Credential |
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Telephone | 888-994-9937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 15-2330
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License Number State | OR
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