Provider Demographics
NPI:1538470992
Name:DEVINE HOME HEALTH CARE AGENCY LLC
Entity Type:Organization
Organization Name:DEVINE HOME HEALTH CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IMA
Authorized Official - Middle Name:AKPABIO
Authorized Official - Last Name:IBAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-557-4665
Mailing Address - Street 1:25511 SOUTHFIELD RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-1856
Mailing Address - Country:US
Mailing Address - Phone:248-557-4665
Mailing Address - Fax:248-557-4665
Practice Address - Street 1:25511 SOUTHFIELD RD
Practice Address - Street 2:SUITE 125
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-1856
Practice Address - Country:US
Practice Address - Phone:248-557-4665
Practice Address - Fax:248-557-4665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health