Provider Demographics
NPI:1629891247
Name:DIVINE SISTERS HEALTHCARE LLC
Entity type:Organization
Organization Name:DIVINE SISTERS HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KORLU
Authorized Official - Middle Name:
Authorized Official - Last Name:BARJOLO
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:562-488-3801
Mailing Address - Street 1:2760 47TH ST S APT 202
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-9152
Mailing Address - Country:US
Mailing Address - Phone:562-488-3801
Mailing Address - Fax:
Practice Address - Street 1:2720 47TH ST S APT 203
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-9156
Practice Address - Country:US
Practice Address - Phone:952-855-6115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care