Provider Demographics
NPI:1851967103
Name:DIVINE HEALTHCARE SERVICES INC
Entity type:Organization
Organization Name:DIVINE HEALTHCARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN,CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-374-7896
Mailing Address - Street 1:2415 DELAMORE CHASE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-5175
Mailing Address - Country:US
Mailing Address - Phone:404-944-1383
Mailing Address - Fax:
Practice Address - Street 1:2415 DELAMORE CHASE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-5175
Practice Address - Country:US
Practice Address - Phone:404-944-1383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care