Provider Demographics
NPI:1215174123
Name:DIVINE ASSURANCE HEALTHCARE SERVICES INC.
Entity type:Organization
Organization Name:DIVINE ASSURANCE HEALTHCARE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OLUGBENGA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-286-8472
Mailing Address - Street 1:2920 VOLTURNO DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-8731
Mailing Address - Country:US
Mailing Address - Phone:469-286-8472
Mailing Address - Fax:
Practice Address - Street 1:2920 VOLTURNO DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-8731
Practice Address - Country:US
Practice Address - Phone:469-286-8472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health