Provider Demographics
NPI:1811226764
Name:DIVINE PROFESSIONALS HEALTHCARE INC.
Entity Type:Organization
Organization Name:DIVINE PROFESSIONALS HEALTHCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ILOANYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-987-1984
Mailing Address - Street 1:7324 SOUTHWEST FWY STE 601
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2043
Mailing Address - Country:US
Mailing Address - Phone:832-987-1984
Mailing Address - Fax:832-539-1952
Practice Address - Street 1:7324 SOUTHWEST FWY STE 601
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074
Practice Address - Country:US
Practice Address - Phone:832-987-1984
Practice Address - Fax:832-539-1952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-23
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
TX013159251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX326076201Medicaid