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General NPI Number Information
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NPI Number | 1730651571
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Entity Type | Organization
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Legal Business Name | DIVINE SUPPORTS
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Dates
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Enumeration Date | 12/18/2018
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Last Update Date | 12/18/2018
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Provider Practice Location Address
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Address Line | 2131 MURFREESBORO PIKE STE 211
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City | NASHVILLE
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State | TN
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Zip | 37217-6316
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Country | US
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Telephone | 615-432-2917
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Fax |
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Provider Business Mailing Address
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Address Line | 2131 MURFREESBORO PIKE STE 211
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City | NASHVILLE
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State | TN
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Zip | 37217-6316
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Country | US
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Telephone | 615-432-2917
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Fax | 615-250-4772
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Authorized Official
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Title or Position | CEO
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Name | MILLICENT IWUCHUKWU
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Credential | DR.
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Telephone | 615-594-7139
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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 |
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License Number State |
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