Provider Demographics
NPI:1851118582
Name:NGA DIVINITY HOMECARE SERVICE
Entity type:Organization
Organization Name:NGA DIVINITY HOMECARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:QUANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:STRACHAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:860-796-3269
Mailing Address - Street 1:5 PLUM RDG
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-1914
Mailing Address - Country:US
Mailing Address - Phone:860-796-3269
Mailing Address - Fax:
Practice Address - Street 1:5 PLUM RDG
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-1914
Practice Address - Country:US
Practice Address - Phone:860-796-3269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care