Provider Demographics
NPI:1942849435
Name:DIVINE NURSE CONSULTANT LLC
Entity Type:Organization
Organization Name:DIVINE NURSE CONSULTANT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:CHUKS
Authorized Official - Last Name:AFAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-622-8530
Mailing Address - Street 1:5633 MONROE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-5591
Mailing Address - Country:US
Mailing Address - Phone:980-622-8530
Mailing Address - Fax:
Practice Address - Street 1:5633 MONROE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-5591
Practice Address - Country:US
Practice Address - Phone:980-622-8530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIVINE NURSE CONSULTANT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care