Provider Demographics
NPI:1417729237
Name:DIVINE ANGELS HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:DIVINE ANGELS HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:NIBITANGA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIBITANGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-822-7449
Mailing Address - Street 1:1444 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-3210
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1444 4TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3210
Practice Address - Country:US
Practice Address - Phone:412-334-1197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NIBITANGA EVELINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities