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General NPI Number Information
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NPI Number | 1689828485
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Entity Type | Organization
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Legal Business Name | DIVINE CAREGIVERS
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Dates
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Enumeration Date | 11/06/2008
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Last Update Date | 11/06/2008
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Provider Practice Location Address
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Address Line | 9920 WENDT WAY
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City | STOCKTON
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State | CA
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Zip | 95209-4523
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Country | US
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Telephone | 209-483-3466
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Fax |
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Provider Business Mailing Address
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Address Line | 9920 WENDT WAY
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City | STOCKTON
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State | CA
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Zip | 95209-4523
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Country | US
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Telephone | 209-483-3466
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GWENDOLYN BOSS
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Credential |
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Telephone | 209-483-3466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 0900096452
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License Number State | CA
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