MEDICARE: CHIKA DIVINE CARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	R2853P	MD

General Provider Information

NPI Number	:	1013239698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIKA DIVINE CARE INC

Provider Business Mailing Address
First Line	:	1808 WOODLAWN DR STE S
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21207-4023
Country	:	US
Telephone Number	:	410-265-9502
Fax Number	:	410-265-9504

Provider Business Practice Location Address
First Line	:	1808 WOODLAWN DR STE S
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21207-4023
Country	:	US
Telephone Number	:	410-265-9502
Fax Number	:	410-265-9504

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MRS. BENEDICTA CHIKA MLEMCHUKWU
Credential	:	BS
Telephone Number	:	410-265-9502

Provider Enumeration Date	:	02/23/2010
Last Update Date	:	02/23/2010

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