Provider Demographics
NPI:1144868258
Name:DIVINE HEALTH CARE INC
Entity type:Organization
Organization Name:DIVINE HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ISATU
Authorized Official - Middle Name:
Authorized Official - Last Name:FORNAH-JAMBAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-640-6229
Mailing Address - Street 1:1629 K ST NW STE 300
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-1631
Mailing Address - Country:US
Mailing Address - Phone:301-640-6229
Mailing Address - Fax:240-547-6299
Practice Address - Street 1:1629 K ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-1602
Practice Address - Country:US
Practice Address - Phone:301-640-6229
Practice Address - Fax:240-547-6299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-19
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251J00000XAgenciesNursing Care