Provider Demographics
NPI:1336619162
Name:ADVANCE DIVINE HEALTHCARE INC
Entity type:Organization
Organization Name:ADVANCE DIVINE HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CELESTINE
Authorized Official - Middle Name:U
Authorized Official - Last Name:OHALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-447-4085
Mailing Address - Street 1:1440 HOW LANE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902
Mailing Address - Country:US
Mailing Address - Phone:732-447-4085
Mailing Address - Fax:732-418-1511
Practice Address - Street 1:1440 HOW LANE
Practice Address - Street 2:SUITE 2A
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902
Practice Address - Country:US
Practice Address - Phone:732-447-4085
Practice Address - Fax:732-418-1511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-05
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities