Provider Demographics
NPI:1114216553
Name:DEVINE HEALTH,LLC
Entity Type:Organization
Organization Name:DEVINE HEALTH,LLC
Other - Org Name:DEVINE HEALTH,LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:AKUA
Authorized Official - Middle Name:
Authorized Official - Last Name:FREMPOMAH
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:614-772-4460
Mailing Address - Street 1:681 BANKVIEW DR
Mailing Address - Street 2:681 BANKVIEW DR
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-5787
Mailing Address - Country:US
Mailing Address - Phone:614-772-4460
Mailing Address - Fax:614-532-5826
Practice Address - Street 1:681 BANKVIEW DR
Practice Address - Street 2:681 BANKVIEW DR
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-5787
Practice Address - Country:US
Practice Address - Phone:614-772-4460
Practice Address - Fax:614-532-5826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2552009251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health