Provider Demographics
NPI:1184391104
Name:DEVINE VENTURE ENTERPRISES. LLC
Entity type:Organization
Organization Name:DEVINE VENTURE ENTERPRISES. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:REED
Authorized Official - Last Name:BORIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-822-3567
Mailing Address - Street 1:26015 ECHO MTN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-6285
Mailing Address - Country:US
Mailing Address - Phone:830-822-3567
Mailing Address - Fax:
Practice Address - Street 1:6391 DE ZAVALA RD STE 104
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2144
Practice Address - Country:US
Practice Address - Phone:830-822-3567
Practice Address - Fax:210-855-0310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health