Provider Demographics
NPI:1013556570
Name:DIVINE VISION NURSE STAFFING LLC
Entity Type:Organization
Organization Name:DIVINE VISION NURSE STAFFING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DON
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANIGWE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:301-712-2794
Mailing Address - Street 1:211 DAUNTLY ST
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1809
Mailing Address - Country:US
Mailing Address - Phone:301-712-2794
Mailing Address - Fax:301-202-8143
Practice Address - Street 1:211 DAUNTLY ST
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1809
Practice Address - Country:US
Practice Address - Phone:301-712-2794
Practice Address - Fax:301-202-8143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health