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General NPI Number Information
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NPI Number | 1790975571
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Entity Type | Organization
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Legal Business Name | DIVINE HEALTH CARE SERVICES, INC
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Dates
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Enumeration Date | 07/27/2007
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Last Update Date | 07/27/2007
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Provider Practice Location Address
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Address Line | 6800 CASTOR AVE SUITE D
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City | PHILADELPHIA
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State | PA
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Zip | 19149-2106
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Country | US
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Telephone | 215-745-8492
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Fax | 215-745-8482
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Provider Business Mailing Address
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Address Line | 6800 CASTOR AVE SUITE D
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City | PHILADELPHIA
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State | PA
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Zip | 19149-2106
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Country | US
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Telephone | 215-745-8492
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Fax | 215-745-8482
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Authorized Official
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Title or Position | ADMISTRATOR/DPS
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Name | MRS. NORENE A ESSIEN-ETOKIMOH
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Credential | RN
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Telephone | 215-745-8492
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 02940501
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License Number State | PA
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