Provider Demographics
NPI:1477347417
Name:DVINE HEALTHCARE INC
Entity type:Organization
Organization Name:DVINE HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEPHTHAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ASIMOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-431-0618
Mailing Address - Street 1:801 E PULASKI HWY STE 143
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6671
Mailing Address - Country:US
Mailing Address - Phone:443-431-0618
Mailing Address - Fax:
Practice Address - Street 1:21 TREEWAY CT APT 2C
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3489
Practice Address - Country:US
Practice Address - Phone:443-431-0618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-07
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care