Provider Demographics
NPI:1811549249
Name:DIVINE HOME HEALTH CARE
Entity Type:Organization
Organization Name:DIVINE HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:ENABOSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-300-8371
Mailing Address - Street 1:C2 BRIER HILL COURT
Mailing Address - Street 2:#210
Mailing Address - City:EAST BRUNSWICKK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816
Mailing Address - Country:US
Mailing Address - Phone:732-300-8371
Mailing Address - Fax:
Practice Address - Street 1:C2 BRIER HILL COURT
Practice Address - Street 2:#210
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-2090
Practice Address - Country:US
Practice Address - Phone:732-300-8371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-16
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty