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General NPI Number Information
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NPI Number | 1760752463
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Entity Type | Organization
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Legal Business Name | DIVINE LIVING WATERS ELDER CARE SERVICES
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Dates
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Enumeration Date | 01/11/2012
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 2607 BRIGHTON RD
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City | TALLAHASSEE
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State | FL
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Zip | 32301-6531
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Country | US
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Telephone | 850-210-8899
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Fax |
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Provider Business Mailing Address
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Address Line | 2607 BRIGHTON ROAD
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City | TALLAHASSEE
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State | FL
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Zip | 32305
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Country | US
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Telephone | 850-210-8899
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | TUNYA R FIELDS
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Credential | M.S.W.
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Telephone | 850-210-8899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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