Provider Demographics
NPI:1952788283
Name:DIVINE CONSULTING SERVICES
Entity Type:Organization
Organization Name:DIVINE CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TARGETED CASE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:RUBY
Authorized Official - Last Name:HERNANDEZ-
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:302-222-1956
Mailing Address - Street 1:750 S ORANGE BLOSSOM TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-3118
Mailing Address - Country:US
Mailing Address - Phone:321-732-8480
Mailing Address - Fax:321-558-7044
Practice Address - Street 1:750 S ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-3118
Practice Address - Country:US
Practice Address - Phone:321-732-8480
Practice Address - Fax:321-558-7044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service