Provider Demographics
NPI:1356700231
Name:DIVINE COMPANION CARE LLC
Entity type:Organization
Organization Name:DIVINE COMPANION CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:DANKWAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-225-1114
Mailing Address - Street 1:761 N SALINA ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13208-2510
Mailing Address - Country:US
Mailing Address - Phone:315-424-3700
Mailing Address - Fax:315-410-5664
Practice Address - Street 1:761 N SALINA ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13208-2510
Practice Address - Country:US
Practice Address - Phone:315-424-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization