Provider Demographics
NPI:1124779939
Name:DIVERGENT HEALTHCARE SOLUTIONS LLC
Entity type:Organization
Organization Name:DIVERGENT HEALTHCARE SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:757-295-8105
Mailing Address - Street 1:2010 OLD GREENBRIER RD STE A
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2619
Mailing Address - Country:US
Mailing Address - Phone:757-295-8105
Mailing Address - Fax:757-312-8478
Practice Address - Street 1:2010 OLD GREENBRIER RD STE A
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2619
Practice Address - Country:US
Practice Address - Phone:757-295-8105
Practice Address - Fax:757-312-8478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory