MEDICARE: DIVINE EXXPECTATIONS

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1942058953
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE EXXPECTATIONS

Provider Business Mailing Address
First Line	:	790 N MILWAUKEE ST STE 302
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-4073
Country	:	US
Telephone Number	:	414-275-0528
Fax Number	:

Provider Business Practice Location Address
First Line	:	790 N MILWAUKEE ST STE 302
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-4073
Country	:	US
Telephone Number	:	414-275-0528
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. SAVANNAH DRYDEN
Credential	:
Telephone Number	:	414-275-0528

Provider Enumeration Date	:	05/07/2024
Last Update Date	:	05/07/2024

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Directions to “DIVINE EXXPECTATIONS ” Practice Location

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