Provider Demographics
NPI:1528562881
Name:DIVA MULTICARE SERVICES INC.
Entity Type:Organization
Organization Name:DIVA MULTICARE SERVICES INC.
Other - Org Name:DIVA MULTICARE SERVICES INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OMOWUMI
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:AWE-ODIGIE
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:718-775-6346
Mailing Address - Street 1:25721 145TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-3314
Mailing Address - Country:US
Mailing Address - Phone:516-266-6434
Mailing Address - Fax:
Practice Address - Street 1:25721 145TH AVE
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-3314
Practice Address - Country:US
Practice Address - Phone:516-266-6434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2425L251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care