Provider Demographics
NPI:1275045155
Name:ELDIVINE CARE LLC
Entity Type:Organization
Organization Name:ELDIVINE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVANGELINE
Authorized Official - Middle Name:N
Authorized Official - Last Name:EZIKE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:973-207-9886
Mailing Address - Street 1:142 MIDLAND PL
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07106-3311
Mailing Address - Country:US
Mailing Address - Phone:973-207-9886
Mailing Address - Fax:973-416-2825
Practice Address - Street 1:142 MIDLAND PL
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07106-3311
Practice Address - Country:US
Practice Address - Phone:973-207-9886
Practice Address - Fax:973-416-2825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health
No282E00000XHospitalsLong Term Care Hospital
No282N00000XHospitalsGeneral Acute Care Hospital
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric