Provider Demographics
NPI:1881152619
Name:DIVINE HEALTHCARE SERVICES
Entity type:Organization
Organization Name:DIVINE HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIVINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELPHSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-413-5614
Mailing Address - Street 1:8222 NORTHVIEW CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5880
Mailing Address - Country:US
Mailing Address - Phone:240-413-5614
Mailing Address - Fax:
Practice Address - Street 1:8222 NORTHVIEW CT
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5880
Practice Address - Country:US
Practice Address - Phone:240-413-5614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services