Provider Demographics
NPI:1578628632
Name:DIVINE HOME CARE OF OHIO LLC
Entity Type:Organization
Organization Name:DIVINE HOME CARE OF OHIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BABATUNDE
Authorized Official - Middle Name:
Authorized Official - Last Name:ONAMUSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-222-9410
Mailing Address - Street 1:904 N CABLE RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-1704
Mailing Address - Country:US
Mailing Address - Phone:419-222-9410
Mailing Address - Fax:419-222-6175
Practice Address - Street 1:904 N CABLE RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-1704
Practice Address - Country:US
Practice Address - Phone:419-222-9410
Practice Address - Fax:419-222-6175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH36-8156Medicare ID - Type Unspecified