Provider Demographics
NPI:1407500747
Name:DIVINE SUPPORT CENTER LLC
Entity Type:Organization
Organization Name:DIVINE SUPPORT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GINO
Authorized Official - Middle Name:KODJO
Authorized Official - Last Name:HOUANYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-605-5717
Mailing Address - Street 1:7900 E UNION AVE STE 1100
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-2746
Mailing Address - Country:US
Mailing Address - Phone:843-605-5717
Mailing Address - Fax:
Practice Address - Street 1:7900 E UNION AVE STE 1100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-2746
Practice Address - Country:US
Practice Address - Phone:843-605-5717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-06
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty