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General NPI Number Information
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NPI Number | 1811395692
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Entity Type | Organization
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Legal Business Name | DIVINE LIVING HOMES
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Dates
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Enumeration Date | 12/10/2014
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Last Update Date | 12/10/2014
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Provider Practice Location Address
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Address Line | 16214 WOODBINE ST
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City | DETROIT
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State | MI
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Zip | 48219
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Country | US
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Telephone | 313-246-6182
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Fax | 313-766-5848
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Provider Business Mailing Address
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Address Line | 16214 WOODBINE ST
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City | DETROIT
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State | MI
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Zip | 48219
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Country | US
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Telephone | 313-246-6182
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Fax | 313-766-5848
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Authorized Official
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Title or Position | PUBLIC RELATIONSOFFICER
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Name | JOHN OPARA
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Credential |
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Telephone | 734-262-9408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number | 4704283827
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 4704261009
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License Number State | MI
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