Provider Demographics
NPI:1922275841
Name:DIVINE E AND K HEALTHCARE SERVICES, INC.
Entity Type:Organization
Organization Name:DIVINE E AND K HEALTHCARE SERVICES, INC.
Other - Org Name:DIVINE E AND K HEALTHCARE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DON ; ASST. ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:O
Authorized Official - Last Name:CHIDUME
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:817-800-5315
Mailing Address - Street 1:5005 SUMMER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-1347
Mailing Address - Country:US
Mailing Address - Phone:817-800-5315
Mailing Address - Fax:817-466-4161
Practice Address - Street 1:5005 SUMMER CREEK DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-1347
Practice Address - Country:US
Practice Address - Phone:817-800-5315
Practice Address - Fax:817-466-4161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health