Provider Demographics
NPI:1891006029
Name:DIVINE FAVOUR HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:DIVINE FAVOUR HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:UBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-577-3137
Mailing Address - Street 1:10640 N 28TH DR # 205-20
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4527
Mailing Address - Country:US
Mailing Address - Phone:602-795-5450
Mailing Address - Fax:
Practice Address - Street 1:10640 N 28TH DR # 205-20
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4527
Practice Address - Country:US
Practice Address - Phone:602-795-5450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA4843251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health