Provider Demographics
NPI:1922252709
Name:DIVINE HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:DIVINE HEALTH CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:CONTEH
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:301-257-7575
Mailing Address - Street 1:9470 ANNAPOLIS RD
Mailing Address - Street 2:SUITE 413
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3025
Mailing Address - Country:US
Mailing Address - Phone:301-459-2583
Mailing Address - Fax:
Practice Address - Street 1:9470 ANNAPOLIS RD
Practice Address - Street 2:SUITE 413
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3025
Practice Address - Country:US
Practice Address - Phone:301-459-2583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2628251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health