Provider Demographics
NPI:1629532114
Name:DIVINE HERITAGE INC
Entity Type:Organization
Organization Name:DIVINE HERITAGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:OKORODUDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-898-2660
Mailing Address - Street 1:9317 OWINGS CHOICE CT
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-6345
Mailing Address - Country:US
Mailing Address - Phone:443-898-2660
Mailing Address - Fax:
Practice Address - Street 1:9317 OWINGS CHOICE CT
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-6345
Practice Address - Country:US
Practice Address - Phone:443-898-2660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities