Provider Demographics
NPI:1275069239
Name:DIVINE CARE LLC
Entity Type:Organization
Organization Name:DIVINE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:O
Authorized Official - Last Name:BALOGUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-400-3186
Mailing Address - Street 1:3354 MEADOWSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SACHSE
Mailing Address - State:TX
Mailing Address - Zip Code:75048
Mailing Address - Country:US
Mailing Address - Phone:972-400-3186
Mailing Address - Fax:
Practice Address - Street 1:3354 MEADOWSIDE DR
Practice Address - Street 2:
Practice Address - City:SACHSE
Practice Address - State:TX
Practice Address - Zip Code:75048-2270
Practice Address - Country:US
Practice Address - Phone:972-400-3186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX802713080OtherNONE