Provider Demographics
NPI:1023424827
Name:DIVINE HEALTH HOME CARE SERVICES,INC
Entity type:Organization
Organization Name:DIVINE HEALTH HOME CARE SERVICES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINITRATORR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESSIEN-ETOKIMOH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:267-686-4872
Mailing Address - Street 1:6800 CASTOR AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-2100
Mailing Address - Country:US
Mailing Address - Phone:267-686-4872
Mailing Address - Fax:267-686-4873
Practice Address - Street 1:6800 CASTOR AVE
Practice Address - Street 2:SUITE C
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19149-2100
Practice Address - Country:US
Practice Address - Phone:267-686-4872
Practice Address - Fax:267-686-4873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility