Provider Demographics
NPI:1376149468
Name:DIVINE LIGHT HOMECARE LLC
Entity Type:Organization
Organization Name:DIVINE LIGHT HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/AGENCY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IMOLEAYO
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:OLUYEDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-792-6477
Mailing Address - Street 1:71 NICHOLAS DR W
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-6221
Mailing Address - Country:US
Mailing Address - Phone:312-792-6477
Mailing Address - Fax:847-789-9728
Practice Address - Street 1:875 N MICHIGAN AVE # 3178
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1803
Practice Address - Country:US
Practice Address - Phone:224-488-0600
Practice Address - Fax:847-789-9728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care