Provider Demographics
NPI:1013023001
Name:DIVINITY HEALTH SERVICES
Entity Type:Organization
Organization Name:DIVINITY HEALTH SERVICES
Other - Org Name:DIVINITY HEALTH SERVICES, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:OAKS
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:713-283-0050
Mailing Address - Street 1:5326 W BELLFORT ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-3041
Mailing Address - Country:US
Mailing Address - Phone:713-283-0050
Mailing Address - Fax:
Practice Address - Street 1:5326 W BELLFORT ST
Practice Address - Street 2:SUITE 110
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-3041
Practice Address - Country:US
Practice Address - Phone:713-283-0050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
TX011241251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFILE # 0800642441OtherITIN 32019593717