Provider Demographics
NPI:1790975571
Name:DIVINE HEALTH CARE SERVICES, INC
Entity Type:Organization
Organization Name:DIVINE HEALTH CARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMISTRATOR/DPS
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESSIEN-ETOKIMOH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:215-745-8492
Mailing Address - Street 1:6800 CASTOR AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-2106
Mailing Address - Country:US
Mailing Address - Phone:215-745-8492
Mailing Address - Fax:215-745-8482
Practice Address - Street 1:6800 CASTOR AVE
Practice Address - Street 2:SUITE D
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-2106
Practice Address - Country:US
Practice Address - Phone:215-745-8492
Practice Address - Fax:215-745-8482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA02940501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health