Provider Demographics
NPI:1942504121
Name:DIVINE PROMISES NURSING AGENCY
Entity Type:Organization
Organization Name:DIVINE PROMISES NURSING AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TITILOLA
Authorized Official - Middle Name:HARRIET
Authorized Official - Last Name:ADANRITAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:619-334-3438
Mailing Address - Street 1:1630 WALLY WAY
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-3684
Mailing Address - Country:US
Mailing Address - Phone:619-334-3438
Mailing Address - Fax:619-334-3438
Practice Address - Street 1:1630 WALLY WAY
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-3684
Practice Address - Country:US
Practice Address - Phone:619-334-3438
Practice Address - Fax:619-334-3438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA643553251J00000X, 385H00000X
282E00000X, 283Q00000X, 3104A0625X, 313M00000X, 320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No251J00000XAgenciesNursing Care
No282E00000XHospitalsLong Term Care Hospital
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No385H00000XRespite Care FacilityRespite Care