Provider Demographics
NPI:1942534516
Name:I DEVINE-CARE MEDICAL DME & SUPPLY
Entity Type:Organization
Organization Name:I DEVINE-CARE MEDICAL DME & SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:IKECHUKWU
Authorized Official - Middle Name:STANISLAUS
Authorized Official - Last Name:IWUNNAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-215-9026
Mailing Address - Street 1:3201 INTERSTATE HIGHWAY 30
Mailing Address - Street 2:SUITE C2
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-2605
Mailing Address - Country:US
Mailing Address - Phone:972-279-0643
Mailing Address - Fax:972-279-0543
Practice Address - Street 1:3201 INTERSTATE HIGHWAY 30
Practice Address - Street 2:SUITE C2
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-2605
Practice Address - Country:US
Practice Address - Phone:972-279-0643
Practice Address - Fax:972-279-0543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0109451332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies