Provider Demographics
NPI:1104613314
Name:DIVINE HARLEM LLC
Entity type:Organization
Organization Name:DIVINE HARLEM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEMARISA
Authorized Official - Middle Name:N
Authorized Official - Last Name:TOMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-740-6246
Mailing Address - Street 1:1631 PATERSON PLANK RD APT 326
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-4173
Mailing Address - Country:US
Mailing Address - Phone:646-241-1419
Mailing Address - Fax:
Practice Address - Street 1:252 W 149TH ST APT 4B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-2845
Practice Address - Country:US
Practice Address - Phone:646-241-1419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty