Provider Demographics
NPI:1871189985
Name:DIVINE LIVING LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:DIVINE LIVING LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ASSISTED LIVING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:EGBIREMOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-682-3762
Mailing Address - Street 1:8620 PLEASANT PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-2351
Mailing Address - Country:US
Mailing Address - Phone:443-682-3762
Mailing Address - Fax:
Practice Address - Street 1:202 E LANVALE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2814
Practice Address - Country:US
Practice Address - Phone:443-682-3762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility