Provider Demographics
NPI:1366333452
Name:DIVINE FAVOR LLC
Entity type:Organization
Organization Name:DIVINE FAVOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:DENISIE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-400-7734
Mailing Address - Street 1:5759 CHIPMUNK RUN APT A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-1474
Mailing Address - Country:US
Mailing Address - Phone:317-400-7734
Mailing Address - Fax:317-707-9505
Practice Address - Street 1:825 S ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46619-2914
Practice Address - Country:US
Practice Address - Phone:317-400-7734
Practice Address - Fax:317-707-9505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care