Provider Demographics
NPI:1376274670
Name:DIVINE HOME COMMUNITY SERVICES INC
Entity Type:Organization
Organization Name:DIVINE HOME COMMUNITY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:CHINYERE
Authorized Official - Last Name:MADUBUKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-334-1121
Mailing Address - Street 1:12902 OLD CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4616
Mailing Address - Country:US
Mailing Address - Phone:240-334-1121
Mailing Address - Fax:240-540-4963
Practice Address - Street 1:12902 OLD CHAPEL RD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-4616
Practice Address - Country:US
Practice Address - Phone:240-334-1121
Practice Address - Fax:240-540-4963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-19
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health