Provider Demographics
NPI:1902561087
Name:DIVINE GLOBAL HEALTHCARE INC
Entity Type:Organization
Organization Name:DIVINE GLOBAL HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:AYO
Authorized Official - Middle Name:DOROTHY
Authorized Official - Last Name:SIRLEAF
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED VOCATIONAL
Authorized Official - Phone:281-779-0961
Mailing Address - Street 1:18534 SANDELFORD DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-8444
Mailing Address - Country:US
Mailing Address - Phone:128-177-9096
Mailing Address - Fax:
Practice Address - Street 1:18534 SANDELFORD DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-8444
Practice Address - Country:US
Practice Address - Phone:128-177-9096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care