=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679214845
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIVINE HEALTHCARE CONSULTANTS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2022
-----------------------------------------------------
Last Update Date | 04/04/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34 WOOD DRAKE PLACE
-----------------------------------------------------
City | WOODLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77375
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-319-0453
-----------------------------------------------------
Fax | 866-525-0270
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 34 WOOD DRAKE PL
-----------------------------------------------------
City | THE WOODLANDS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77375-4972
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-319-0453
-----------------------------------------------------
Fax | 866-525-0270
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | BRI-ANNA GUILLORY
-----------------------------------------------------
Credential | LVN-WCN-C
-----------------------------------------------------
Telephone | 832-228-6988
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------