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General NPI Number Information
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NPI Number | 1962223131
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Entity Type | Organization
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Legal Business Name | DIVINE HOME CARE OF MICHIGAN
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 25164 MAPLEBROOKE DR
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City | SOUTHFIELD
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State | MI
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Zip | 48033-5282
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Country | US
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Telephone | 248-895-2171
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Fax |
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Provider Business Mailing Address
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Address Line | 25164 MAPLEBROOKE DR
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City | SOUTHFIELD
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State | MI
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Zip | 48033-5282
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Country | US
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Telephone | 248-895-2171
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | PATRICIA MANGUM
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Credential |
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Telephone | 248-895-2171
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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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