Provider Demographics
NPI:1871472357
Name:DIVINE LOVE LLC
Entity type:Organization
Organization Name:DIVINE LOVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BABAKHANOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-899-2365
Mailing Address - Street 1:7080 W. CREEKSIDE COURT
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092
Mailing Address - Country:US
Mailing Address - Phone:414-899-2365
Mailing Address - Fax:
Practice Address - Street 1:11512 N PORT WASHINGTON RD STE 200
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3481
Practice Address - Country:US
Practice Address - Phone:414-242-2838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health