Provider Demographics
NPI:1811395692
Name:DIVINE LIVING HOMES
Entity Type:Organization
Organization Name:DIVINE LIVING HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC RELATIONSOFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:OPARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-262-9408
Mailing Address - Street 1:16214 WOODBINE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219
Mailing Address - Country:US
Mailing Address - Phone:313-246-6182
Mailing Address - Fax:313-766-5848
Practice Address - Street 1:16214 WOODBINE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219
Practice Address - Country:US
Practice Address - Phone:313-246-6182
Practice Address - Fax:313-766-5848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704261009311ZA0620X
MI4704283827332BN1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies