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General NPI Number Information
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NPI Number | 1902561087
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Entity Type | Organization
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Legal Business Name | DIVINE GLOBAL HEALTHCARE INC
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Dates
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Enumeration Date | 11/03/2021
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Last Update Date | 11/03/2021
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Provider Practice Location Address
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Address Line | 18534 SANDELFORD DR
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City | KATY
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State | TX
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Zip | 77449-8444
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Country | US
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Telephone | 128-177-9096
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Fax |
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Provider Business Mailing Address
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Address Line | 18534 SANDELFORD DR
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City | KATY
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State | TX
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Zip | 77449-8444
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Country | US
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Telephone | 128-177-9096
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MISS AYO DOROTHY SIRLEAF
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Credential | LICENSED VOCATIONAL
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Telephone | 281-779-0961
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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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