Provider Demographics
NPI:1619566924
Name:DIVINE TOUCH OF IOWA LLC
Entity Type:Organization
Organization Name:DIVINE TOUCH OF IOWA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AGBOR ANTHONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MBU-OROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-213-6881
Mailing Address - Street 1:8350 CASCADE AVE UNIT 9207
Mailing Address - Street 2:
Mailing Address - City:WDM
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8716
Mailing Address - Country:US
Mailing Address - Phone:202-213-6881
Mailing Address - Fax:
Practice Address - Street 1:8350 CASCADE AVE UNIT 9207
Practice Address - Street 2:
Practice Address - City:WDM
Practice Address - State:IA
Practice Address - Zip Code:50266-8716
Practice Address - Country:US
Practice Address - Phone:641-980-4465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities