Provider Demographics
NPI:1932583879
Name:DIVINE NURSE CONSULTANT
Entity Type:Organization
Organization Name:DIVINE NURSE CONSULTANT
Other - Org Name:DIVINE MANOR ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:C
Authorized Official - Last Name:AFAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-622-8530
Mailing Address - Street 1:2210 OAK POND RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-7958
Mailing Address - Country:US
Mailing Address - Phone:803-329-4494
Mailing Address - Fax:803-329-5902
Practice Address - Street 1:2210 OAK POND RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-7958
Practice Address - Country:US
Practice Address - Phone:803-329-4494
Practice Address - Fax:803-329-5902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-09
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRC1361310400000X, 3104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRC1361OtherFACILITY NUMBER