Provider Demographics
NPI:1407536931
Name:DIVINITY HEALTHCARE LLC
Entity Type:Organization
Organization Name:DIVINITY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DWUMAH
Authorized Official - Last Name:BROBBEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-343-6935
Mailing Address - Street 1:9 FULTON DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7827
Mailing Address - Country:US
Mailing Address - Phone:571-343-6935
Mailing Address - Fax:
Practice Address - Street 1:9 FULTON DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7827
Practice Address - Country:US
Practice Address - Phone:571-343-6935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-19
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care