Provider Demographics
NPI:1326169848
Name:DIVINE CARE HEALT SERVICES
Entity Type:Organization
Organization Name:DIVINE CARE HEALT SERVICES
Other - Org Name:NDUBUISI DAVID ACHO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-930-0930
Mailing Address - Street 1:6850 MANHATTAN BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120-1227
Mailing Address - Country:US
Mailing Address - Phone:817-930-0930
Mailing Address - Fax:
Practice Address - Street 1:6850 MANHATTAN BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76120-1227
Practice Address - Country:US
Practice Address - Phone:817-930-0930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007277251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
679011Medicare Oscar/Certification