Provider Demographics
NPI:1528476173
Name:DIVINE HEALTHCARE SERVICES,INC
Entity type:Organization
Organization Name:DIVINE HEALTHCARE SERVICES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:CONTEH
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:301-257-7575
Mailing Address - Street 1:1818 NEW YORK AVE NE STE 228
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-1851
Mailing Address - Country:US
Mailing Address - Phone:301-257-7575
Mailing Address - Fax:
Practice Address - Street 1:1818 NEW YORK AVE NE STE 228
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1851
Practice Address - Country:US
Practice Address - Phone:301-257-7575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-28
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNSA0230253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care