Provider Demographics
NPI:1780920801
Name:DIVINE HEALTH CONSULTANTS
Entity type:Organization
Organization Name:DIVINE HEALTH CONSULTANTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:O
Authorized Official - Last Name:AFAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:803-448-0251
Mailing Address - Street 1:7516 EAST INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-9414
Mailing Address - Country:US
Mailing Address - Phone:704-512-0162
Mailing Address - Fax:704-512-0165
Practice Address - Street 1:7516 E INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-9475
Practice Address - Country:US
Practice Address - Phone:704-512-0162
Practice Address - Fax:704-512-0165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251J00000X, 253Z00000X, 261QP2000X, 251E00000X
NCHC4586261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy