Provider Demographics
NPI:1376378521
Name:DIVINE PERSONAL CARE AGENCY
Entity type:Organization
Organization Name:DIVINE PERSONAL CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-232-3962
Mailing Address - Street 1:1009 W GLEN OAKS LN STE 201
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3383
Mailing Address - Country:US
Mailing Address - Phone:414-309-9700
Mailing Address - Fax:262-236-9536
Practice Address - Street 1:1009 W GLEN OAKS LN STE 201
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3383
Practice Address - Country:US
Practice Address - Phone:414-309-9700
Practice Address - Fax:262-236-9536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care