Provider Demographics
NPI:1275269326
Name:DIVINITY CHRONIC CARE MANAGEMENT
Entity Type:Organization
Organization Name:DIVINITY CHRONIC CARE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:GERI
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:267-536-9188
Mailing Address - Street 1:313 BAINBRIDGE ST FL 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1542
Mailing Address - Country:US
Mailing Address - Phone:877-348-8333
Mailing Address - Fax:
Practice Address - Street 1:313 BAINBRIDGE ST FL 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-1542
Practice Address - Country:US
Practice Address - Phone:877-348-8333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-29
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management