MEDICARE: DIVINE PROVIDENCE 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1558824607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE PROVIDENCE INC

Provider Business Mailing Address
First Line	:	11055 KILKERRAN CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-4356
Country	:	US
Telephone Number	:	954-663-1759
Fax Number	:

Provider Business Practice Location Address
First Line	:	1729 E CHARLESTON BLVD STE F
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-1986
Country	:	US
Telephone Number	:	954-663-1759
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. MODUPE IROROBEJE
Credential	:
Telephone Number	:	702-778-3072

Provider Enumeration Date	:	04/06/2019
Last Update Date	:	04/06/2019

Similar Medicare Providers

1154733905 — DIVINE PROVIDENCE INC
Practice Location Address:

1729 E CHARLESTON BLVD STE F
LAS VEGAS, NV
89104-1986

Practice Phone: 702-778-3072
Practice Fax: 702-778-0512

1013066125 — MARK F SEVERINO MD
Practice Location Address:

5320 S. RAINBOW BLVD , STE 300
LAS VEGAS, NV
89118-1986

Practice Phone: 702-794-0073
Practice Fax: 702-794-0042

1831049444 — PREMIER HOME CARE SERVICES
Practice Location Address:

1913 S EASTERN AVE
LAS VEGAS, NV
89104-3917

Practice Phone: 702-986-8514
Practice Fax: 702-986-8514

1356291967 — PREMIER HOME CARE SERVICES
Practice Location Address:

1913 S EASTERN AVE
LAS VEGAS, NV
89104-3917

Practice Phone: 702-629-9033
Practice Fax: 702-331-3886

1912857483 — JORDAN JAVON THOMAS
Practice Location Address:

1820 E SAHARA AVE STE 114
LAS VEGAS, NV
89104-3736

Practice Phone: 702-262-1202
Practice Fax: 702-749-6232

1497758197 — DR. KENNETH JARVIS DPM
Practice Location Address:

1200 S 4TH ST STE 111
LAS VEGAS, NV
89104-1046

Practice Phone: 702-810-1748
Practice Fax: 702-837-8292

Directions to “DIVINE PROVIDENCE INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.