Provider Demographics
NPI:1487845996
Name:DIVINE MOBILITY & COMFORT, INC
Entity Type:Organization
Organization Name:DIVINE MOBILITY & COMFORT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-360-3787
Mailing Address - Street 1:8574 W LAKE MEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7630
Mailing Address - Country:US
Mailing Address - Phone:702-360-3787
Mailing Address - Fax:702-433-3787
Practice Address - Street 1:8574 W LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-7630
Practice Address - Country:US
Practice Address - Phone:702-360-3787
Practice Address - Fax:702-433-3787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV6067950001Medicare NSC