Provider Demographics
NPI:1740450592
Name:DIVINE CARE MEDICAL SUPPLY SERVICES
Entity type:Organization
Organization Name:DIVINE CARE MEDICAL SUPPLY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEHINDE
Authorized Official - Middle Name:
Authorized Official - Last Name:AKOJENU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-228-0829
Mailing Address - Street 1:11703 197TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-3453
Mailing Address - Country:US
Mailing Address - Phone:646-228-0829
Mailing Address - Fax:
Practice Address - Street 1:11703 197TH ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-3453
Practice Address - Country:US
Practice Address - Phone:646-228-0829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FEMSAM LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1189667332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies