Provider Demographics
NPI:1427458983
Name:DIVINE INVESTMENT LLC
Entity type:Organization
Organization Name:DIVINE INVESTMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSH
Authorized Official - Middle Name:
Authorized Official - Last Name:GODSPOWER-ODIONG
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:216-526-6024
Mailing Address - Street 1:329 HALLE DR
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-1023
Mailing Address - Country:US
Mailing Address - Phone:216-520-6024
Mailing Address - Fax:216-255-6633
Practice Address - Street 1:329 HALLE DR
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-1023
Practice Address - Country:US
Practice Address - Phone:216-520-6024
Practice Address - Fax:216-255-6633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH189435343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0090624Medicaid