Provider Demographics
NPI:1093042863
Name:DIVINE INTERVENTION HEALTHCARE, INC
Entity Type:Organization
Organization Name:DIVINE INTERVENTION HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRENA
Authorized Official - Middle Name:ARMETTA
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:708-821-5448
Mailing Address - Street 1:2158 45TH ST STE 303
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-3742
Mailing Address - Country:US
Mailing Address - Phone:708-821-5448
Mailing Address - Fax:708-566-5293
Practice Address - Street 1:2158 45TH ST STE 303
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-3742
Practice Address - Country:US
Practice Address - Phone:708-821-5448
Practice Address - Fax:708-566-5293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-15
Last Update Date:2009-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)