Provider Demographics
NPI:1497478184
Name:MAGGIE'S DIVINE HOMES LLC
Entity Type:Organization
Organization Name:MAGGIE'S DIVINE HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ONORIODE
Authorized Official - Middle Name:PAULINE
Authorized Official - Last Name:IGHOFOSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-480-2110
Mailing Address - Street 1:13919 LITTLEBORNE BIRDWELL LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-4530
Mailing Address - Country:US
Mailing Address - Phone:347-480-2110
Mailing Address - Fax:
Practice Address - Street 1:13919 LITTLEBORNE BIRDWELL LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-4530
Practice Address - Country:US
Practice Address - Phone:347-480-2110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-19
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251S00000XAgenciesCommunity/Behavioral Health
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child