Provider Demographics
NPI:1801686720
Name:DIVINE COVENANT CARE
Entity type:Organization
Organization Name:DIVINE COVENANT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AYOADE
Authorized Official - Middle Name:
Authorized Official - Last Name:OYEWOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-473-7383
Mailing Address - Street 1:10428 JOPLIN LN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212-9290
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10428 JOPLIN LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95212-9290
Practice Address - Country:US
Practice Address - Phone:209-473-7383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251J00000XAgenciesNursing Care