Provider Demographics
NPI:1245969245
Name:DEVINE CARE LLC
Entity type:Organization
Organization Name:DEVINE CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ORIABURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-330-6269
Mailing Address - Street 1:10240 N 31ST AVE STE 122
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-9564
Mailing Address - Country:US
Mailing Address - Phone:623-330-6269
Mailing Address - Fax:
Practice Address - Street 1:10240 N 31ST AVE STE 122
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-9564
Practice Address - Country:US
Practice Address - Phone:623-330-6269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty