Provider Demographics
NPI:1285299933
Name:DIVINE PROVIDERS, INC.
Entity type:Organization
Organization Name:DIVINE PROVIDERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:EFFIONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-302-6662
Mailing Address - Street 1:18947 PINE HARVEST LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407
Mailing Address - Country:US
Mailing Address - Phone:281-302-6662
Mailing Address - Fax:281-302-6662
Practice Address - Street 1:18947 PINE HARVEST LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407
Practice Address - Country:US
Practice Address - Phone:281-302-6662
Practice Address - Fax:281-302-6662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty