Provider Demographics
NPI:1588838122
Name:DIVINE LOVE HOMECARE SERVICES, LLC
Entity Type:Organization
Organization Name:DIVINE LOVE HOMECARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:UCHE
Authorized Official - Middle Name:CHINYERE
Authorized Official - Last Name:OBIDIEGWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-251-6610
Mailing Address - Street 1:4600 OXBOROUGH GDNS
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-3910
Mailing Address - Country:US
Mailing Address - Phone:612-251-6610
Mailing Address - Fax:
Practice Address - Street 1:4600 OXBOROUGH GDNS
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-3910
Practice Address - Country:US
Practice Address - Phone:612-251-6610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN276662100251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health