Provider Demographics
NPI:1508982489
Name:DIVINE FAMILY CARE HOME INC.
Entity Type:Organization
Organization Name:DIVINE FAMILY CARE HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:O
Authorized Official - Last Name:ISIJOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-880-4619
Mailing Address - Street 1:306 LUMPKIN BLVD
Mailing Address - Street 2:FRANKLIN COUNTY
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-2143
Mailing Address - Country:US
Mailing Address - Phone:919-729-3134
Mailing Address - Fax:919-729-3134
Practice Address - Street 1:306 LUMPKIN BLVD
Practice Address - Street 2:FRANKLIN COUNTY
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2143
Practice Address - Country:US
Practice Address - Phone:919-729-3134
Practice Address - Fax:919-729-3134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-035-016311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home