Provider Demographics
NPI:1225290430
Name:DIVINE HEALTHCARE SERVICES, LLC.
Entity type:Organization
Organization Name:DIVINE HEALTHCARE SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:F
Authorized Official - Last Name:OBIDIGBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-996-2270
Mailing Address - Street 1:60 EVERGREEN PL STE 501
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2118
Mailing Address - Country:US
Mailing Address - Phone:973-900-0110
Mailing Address - Fax:973-900-0110
Practice Address - Street 1:60 EVERGREEN PL STE 501
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2118
Practice Address - Country:US
Practice Address - Phone:973-900-0110
Practice Address - Fax:973-900-0110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-28
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26N012346500251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care