Provider Demographics
NPI:1225613656
Name:DIVINE CARE SERVICES, LLC
Entity Type:Organization
Organization Name:DIVINE CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NKECHI
Authorized Official - Middle Name:
Authorized Official - Last Name:ILEKA-ADEOYE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:301-523-7456
Mailing Address - Street 1:2052 CHAMBERLAIN DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-3586
Mailing Address - Country:US
Mailing Address - Phone:301-523-7456
Mailing Address - Fax:
Practice Address - Street 1:30 COURTHOUSE SQ STE G1
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-2302
Practice Address - Country:US
Practice Address - Phone:301-966-7610
Practice Address - Fax:301-966-7611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-17
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD824702100Medicaid