Provider Demographics
NPI:1700969607
Name:DIVINE MERCY MEDICAL HEALTH AND EQUIPMENT SUPPLY, INC.
Entity Type:Organization
Organization Name:DIVINE MERCY MEDICAL HEALTH AND EQUIPMENT SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDE
Authorized Official - Middle Name:NNAEMEKA
Authorized Official - Last Name:OKOYEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-288-6871
Mailing Address - Street 1:4507 LAWNDALE DR
Mailing Address - Street 2:# D
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-1882
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:620 S ELM ST
Practice Address - Street 2:SUITE 323
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-1370
Practice Address - Country:US
Practice Address - Phone:336-288-6871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies