Provider Demographics
NPI:1467759779
Name:DIVINE PROMISES NURSING AGENCY
Entity Type:Organization
Organization Name:DIVINE PROMISES NURSING AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TITILOLA
Authorized Official - Middle Name:HARRIET
Authorized Official - Last Name:ADANRITAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-334-3438
Mailing Address - Street 1:1630 WALLY WAY
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-3684
Mailing Address - Country:US
Mailing Address - Phone:619-334-3438
Mailing Address - Fax:619-334-3438
Practice Address - Street 1:1630 WALLY WAY
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-3684
Practice Address - Country:US
Practice Address - Phone:619-334-3438
Practice Address - Fax:619-334-3438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health