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General NPI Number Information
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NPI Number | 1770377657
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Entity Type | Organization
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Legal Business Name | DIVINE CARE LIFE SERVICE
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 301 S 4TH ST
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City | DUQUESNE
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State | PA
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Zip | 15110-1239
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Country | US
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Telephone | 412-313-1176
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Fax |
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Provider Business Mailing Address
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Address Line | 4607 LIBRARY ROAD 220 867
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City | BETHEL PARK
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State | PA
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Zip | 15102
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Country | US
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Telephone | 412-313-1176
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Fax |
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Authorized Official
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Title or Position | COO
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Name | DEONNA A LIGONS
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Credential |
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Telephone | 412-313-1176
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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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