Provider Demographics
NPI:1326913294
Name:MINE DIVINE HEALTH LLC
Entity type:Organization
Organization Name:MINE DIVINE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADESUWA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBASOGIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-217-2076
Mailing Address - Street 1:132 SE CHELSEA CT # LEE
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2472
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:132 SE CHELSEA CT # LEE
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2472
Practice Address - Country:US
Practice Address - Phone:816-217-2076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty