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General NPI Number Information
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NPI Number | 1801686720
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Entity Type | Organization
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Legal Business Name | DIVINE COVENANT CARE
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Dates
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Enumeration Date | 05/12/2025
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 10428 JOPLIN LN
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City | STOCKTON
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State | CA
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Zip | 95212-9290
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Country | US
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Telephone | 209-473-7383
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Fax |
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Provider Business Mailing Address
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Address Line | 10428 JOPLIN LN
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City | STOCKTON
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State | CA
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Zip | 95212-9290
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | AYOADE OYEWOLE
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Credential |
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Telephone | 209-473-7383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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