Provider Demographics
NPI:1396101424
Name:DIVINE HOME HEALTH SERVICES INC
Entity type:Organization
Organization Name:DIVINE HOME HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUTIAT
Authorized Official - Middle Name:
Authorized Official - Last Name:KUFORIJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-829-1348
Mailing Address - Street 1:9245 CALUMET AVE
Mailing Address - Street 2:STE 107
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2821
Mailing Address - Country:US
Mailing Address - Phone:773-829-1348
Mailing Address - Fax:
Practice Address - Street 1:9245 CALUMET AVE
Practice Address - Street 2:STE 107
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2821
Practice Address - Country:US
Practice Address - Phone:773-829-1348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health