Provider Demographics
NPI:1093059321
Name:DIVINE HEALTH CARE SERVICES, INC.
Entity Type:Organization
Organization Name:DIVINE HEALTH CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:CONTEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-257-7575
Mailing Address - Street 1:6315 SEABROOK RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2628
Mailing Address - Country:US
Mailing Address - Phone:301-257-7575
Mailing Address - Fax:301-358-3803
Practice Address - Street 1:6315 SEABROOK RD
Practice Address - Street 2:SUITE 107
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2628
Practice Address - Country:US
Practice Address - Phone:301-257-7575
Practice Address - Fax:301-358-3803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2628R251E00000X
DCNSA-0320251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health