Provider Demographics
NPI:1225815921
Name:DIVINE HOLISTIC CARE INC
Entity Type:Organization
Organization Name:DIVINE HOLISTIC CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRIETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:IWOBI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:424-200-9015
Mailing Address - Street 1:13532 1/2 CHADRON AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-7822
Mailing Address - Country:US
Mailing Address - Phone:424-200-9015
Mailing Address - Fax:855-214-7520
Practice Address - Street 1:13532 1/2 CHADRON AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-7822
Practice Address - Country:US
Practice Address - Phone:424-200-9015
Practice Address - Fax:855-214-7520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty