Provider Demographics
NPI:1629461207
Name:DIVINE MEDICAL EQUIPMENT SUPPLY COMPANY
Entity Type:Organization
Organization Name:DIVINE MEDICAL EQUIPMENT SUPPLY COMPANY
Other - Org Name:DIVINE HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEBO
Authorized Official - Middle Name:
Authorized Official - Last Name:OLANIYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-321-8218
Mailing Address - Street 1:15475 S PARK AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-1328
Mailing Address - Country:US
Mailing Address - Phone:708-321-8218
Mailing Address - Fax:708-321-8219
Practice Address - Street 1:15475 S PARK AVE STE 110
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-1378
Practice Address - Country:US
Practice Address - Phone:708-321-8218
Practice Address - Fax:708-321-8219
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIVINE MEDICAL EQUIPMENT SUPPLY COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-06
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care