Provider Demographics
NPI:1326546508
Name:DIVINE CARE INC.
Entity Type:Organization
Organization Name:DIVINE CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-634-2093
Mailing Address - Street 1:17 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-1600
Mailing Address - Country:US
Mailing Address - Phone:609-634-2093
Mailing Address - Fax:
Practice Address - Street 1:12401 BRICKYARD BLVD APT 1108
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-1356
Practice Address - Country:US
Practice Address - Phone:609-634-2093
Practice Address - Fax:609-634-2093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6096342093Medicaid