Provider Demographics
NPI:1336389642
Name:DIVINE RESTORATION HEALTH CARE SERVICES, INC.
Entity Type:Organization
Organization Name:DIVINE RESTORATION HEALTH CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERLINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEATHERSBY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:504-919-4896
Mailing Address - Street 1:1728 FARRAGUT ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-2928
Mailing Address - Country:US
Mailing Address - Phone:504-338-8088
Mailing Address - Fax:504-309-4341
Practice Address - Street 1:1728 FARRAGUT ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-2928
Practice Address - Country:US
Practice Address - Phone:504-338-8088
Practice Address - Fax:504-309-4341
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIVINE RESTORATION HEALTH CARE SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPCA12199251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services