MEDICARE: DIVINE GUARDIAN HEALTH ASSOCIATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251X00000X	Supports Brokerage Agency
2	251B00000X	Case Management Agency
3	251G00000X	Community Based Hospice Care Agency
4	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
5	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1114622099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE GUARDIAN HEALTH ASSOCIATION

Provider Business Mailing Address
First Line	:	6 KILMER RD # 1328
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08817-2432
Country	:	US
Telephone Number	:	973-847-3006
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 KILMER RD # 1328
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08817-2432
Country	:	US
Telephone Number	:	973-847-3006
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JODIAN WALTERS
Credential	:
Telephone Number	:	973-847-3006

Provider Enumeration Date	:	03/31/2023
Last Update Date	:	03/29/2026

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