Provider Demographics
NPI:1508619602
Name:DIVINE MERCY TENDER LOVING CARE (DMTLC) LLC
Entity Type:Organization
Organization Name:DIVINE MERCY TENDER LOVING CARE (DMTLC) LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, PRESIDENT, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NKEM
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHUKWUMEZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-860-8445
Mailing Address - Street 1:PO BOX 200645
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-0645
Mailing Address - Country:US
Mailing Address - Phone:347-894-8949
Mailing Address - Fax:347-894-8949
Practice Address - Street 1:21451 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-1733
Practice Address - Country:US
Practice Address - Phone:347-894-8949
Practice Address - Fax:347-894-8949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty