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General NPI Number Information
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NPI Number | 1902521057
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Entity Type | Organization
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Legal Business Name | DIVINE GLORY HOMECARE INC
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Dates
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Enumeration Date | 10/10/2022
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 1101 RIDGE RD STE 249
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City | ROCKWALL
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State | TX
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Zip | 75087-4250
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Country | US
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Telephone | 469-300-7724
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Fax | 469-264-5551
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Provider Business Mailing Address
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Address Line | 407 PARKFORD DR
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City | FATE
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State | TX
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Zip | 75087-0950
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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 | DIRECTOR
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Name | MRS. CHIGOZIE ONYERIKAM
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Credential | RN
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Telephone | 317-454-6979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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