Provider Demographics
NPI:1265195069
Name:DIVINE OASIS ALF
Entity type:Organization
Organization Name:DIVINE OASIS ALF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIBEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-988-0333
Mailing Address - Street 1:918 RIDGELAND LN
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-4241
Mailing Address - Country:US
Mailing Address - Phone:305-988-0333
Mailing Address - Fax:813-200-2659
Practice Address - Street 1:918 RIDGELAND LN
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-4241
Practice Address - Country:US
Practice Address - Phone:305-988-0333
Practice Address - Fax:813-200-2659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility