Provider Demographics
NPI:1710415195
Name:DIVINITY GROUP, INC.
Entity Type:Organization
Organization Name:DIVINITY GROUP, INC.
Other - Org Name:BALIMMUNE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:VIGLIOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-249-1609
Mailing Address - Street 1:1223 ENTERPRISE DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33953-3847
Mailing Address - Country:US
Mailing Address - Phone:941-249-1609
Mailing Address - Fax:941-613-9524
Practice Address - Street 1:1223 ENTERPRISE DR UNIT A
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33953-3847
Practice Address - Country:US
Practice Address - Phone:941-249-1609
Practice Address - Fax:941-613-9524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies