Provider Demographics
NPI:1477002053
Name:DIVINE HEALTH SYSTEMS, INC
Entity Type:Organization
Organization Name:DIVINE HEALTH SYSTEMS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OLADUNNI
Authorized Official - Middle Name:
Authorized Official - Last Name:OYEGBILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-873-8757
Mailing Address - Street 1:1900 E NORTHERN PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-2192
Mailing Address - Country:US
Mailing Address - Phone:443-873-8757
Mailing Address - Fax:
Practice Address - Street 1:1900 E NORTHERN PKWY STE 210
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2192
Practice Address - Country:US
Practice Address - Phone:443-873-8757
Practice Address - Fax:443-873-8794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-24
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2127251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health