Provider Demographics
NPI:1144671355
Name:DIVINE LOVE OUTREACH MINISTRIES
Entity type:Organization
Organization Name:DIVINE LOVE OUTREACH MINISTRIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBBER
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:918-403-8404
Mailing Address - Street 1:500 N F ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-4144
Mailing Address - Country:US
Mailing Address - Phone:918-360-2843
Mailing Address - Fax:
Practice Address - Street 1:500 N F ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-4144
Practice Address - Country:US
Practice Address - Phone:918-360-2843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services