Provider Demographics
NPI:1902521057
Name:DIVINE GLORY HOMECARE INC
Entity Type:Organization
Organization Name:DIVINE GLORY HOMECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHIGOZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ONYERIKAM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:317-454-6979
Mailing Address - Street 1:407 PARKFORD DR
Mailing Address - Street 2:
Mailing Address - City:FATE
Mailing Address - State:TX
Mailing Address - Zip Code:75087-0950
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1101 RIDGE RD STE 249
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-4250
Practice Address - Country:US
Practice Address - Phone:469-300-7724
Practice Address - Fax:469-264-5551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-10
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care