Provider Demographics
NPI:1891366902
Name:DIVINE HEALING HEALTHCARE & DURABLE MEDICAL EQUIPMENT LLC
Entity Type:Organization
Organization Name:DIVINE HEALING HEALTHCARE & DURABLE MEDICAL EQUIPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHINYERE
Authorized Official - Middle Name:M
Authorized Official - Last Name:IZUCHUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:678-755-1398
Mailing Address - Street 1:2815 CAROLINA RDG
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-6021
Mailing Address - Country:US
Mailing Address - Phone:678-755-1398
Mailing Address - Fax:877-540-0443
Practice Address - Street 1:2815 CAROLINA RDG
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-6021
Practice Address - Country:US
Practice Address - Phone:678-755-1398
Practice Address - Fax:877-540-0443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-08
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care