Provider Demographics
NPI:1841226578
Name:DIVINE HOSPICE CARE
Entity Type:Organization
Organization Name:DIVINE HOSPICE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:EDOIMIOYA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:404-762-6880
Mailing Address - Street 1:5532 OLD NATIONAL HWY
Mailing Address - Street 2:BLDG G SUITE 100B
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-3212
Mailing Address - Country:US
Mailing Address - Phone:404-762-6880
Mailing Address - Fax:404-762-6885
Practice Address - Street 1:5532 OLD NATIONAL HWY
Practice Address - Street 2:BLDG G SUITE 100B
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-3212
Practice Address - Country:US
Practice Address - Phone:404-762-6880
Practice Address - Fax:404-762-6885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-241-H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111636Medicare Oscar/Certification