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General NPI Number Information
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NPI Number | 1700502630
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Entity Type | Organization
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Legal Business Name | DIVINE ESSENCE ABUNDANCE HOME CARE SERVICES LLC
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Dates
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Enumeration Date | 10/12/2022
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Last Update Date | 10/12/2022
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Provider Practice Location Address
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Address Line | 1811 NORTH REYNOLDS UNIT 101-A
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City | TOLEDO
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State | OH
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Zip | 43615
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Country | US
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Telephone | 567-277-2729
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Fax |
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Provider Business Mailing Address
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Address Line | 1811 NORTH REYNOLDS UNIT 101-A
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City | TOLEDO
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State | OH
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Zip | 43615
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Country | US
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Telephone | 567-277-2729
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Fax |
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Authorized Official
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Title or Position | AGENCY OWNER/ DIRECTOR OF OPERATION
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Name | JERRIKA S JACKSON
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Credential |
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Telephone | 567-277-2729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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