MEDICARE: DEVINE CARE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
3	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1245969245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEVINE CARE LLC

Provider Business Mailing Address
First Line	:	10240 N 31ST AVE STE 122
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-9564
Country	:	US
Telephone Number	:	623-330-6269
Fax Number	:

Provider Business Practice Location Address
First Line	:	10240 N 31ST AVE STE 122
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-9564
Country	:	US
Telephone Number	:	623-330-6269
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DAVID ORIABURE
Credential	:
Telephone Number	:	623-330-6269

Provider Enumeration Date	:	06/07/2022
Last Update Date	:	11/25/2024

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Directions to “DEVINE CARE LLC ” Practice Location

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