Provider Demographics
NPI:1992058242
Name:DIVINE MOTHER LOVE HEALTH CARE SERVICES INC
Entity type:Organization
Organization Name:DIVINE MOTHER LOVE HEALTH CARE SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:OGADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-534-1108
Mailing Address - Street 1:9950 WESTPARK DR
Mailing Address - Street 2:STE 634
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-5138
Mailing Address - Country:US
Mailing Address - Phone:713-534-1108
Mailing Address - Fax:713-534-1203
Practice Address - Street 1:9950 WESTPARK DR STE 634
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-5373
Practice Address - Country:US
Practice Address - Phone:102-815-1541
Practice Address - Fax:888-604-9472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-24
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010114251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX747465Medicare PIN