Provider Demographics
NPI:1649538950
Name:DIVINE TORCH HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:DIVINE TORCH HEALTH SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RN/CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:NGUM
Authorized Official - Last Name:NGANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-225-2160
Mailing Address - Street 1:110 W RANDOL MILL RD STE 242
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-4731
Mailing Address - Country:US
Mailing Address - Phone:817-225-2160
Mailing Address - Fax:817-225-2161
Practice Address - Street 1:110 W RANDOL MILL RD STE 242
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-4731
Practice Address - Country:US
Practice Address - Phone:817-225-2160
Practice Address - Fax:817-225-2161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
TX014746251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0010273101001030839Medicaid