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General NPI Number Information
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NPI Number | 1659076123
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Entity Type | Organization
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Legal Business Name | DIVINE MENTAL HEALTHCARE SERVICES
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Dates
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Enumeration Date | 04/03/2023
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Last Update Date | 04/03/2023
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Provider Practice Location Address
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Address Line | 940 STUYVESANT AVE FL 2
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City | UNION
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State | NJ
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Zip | 07083-6995
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Country | US
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Telephone | 973-223-8417
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Fax | 908-686-9445
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Provider Business Mailing Address
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Address Line | 940 STUYVESANT AVE FL 2
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City | UNION
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State | NJ
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Zip | 07083-6995
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Country | US
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Telephone | 973-223-8417
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Fax | 908-686-9445
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Authorized Official
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Title or Position | CEO
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Name | MS. CHIKAODI C IBEKU
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Credential | DNP & FNP
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Telephone | 973-223-8417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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