Provider Demographics
NPI:1992577944
Name:DIVINE OASIS HOME HEALTH SERVICES LLC
Entity type:Organization
Organization Name:DIVINE OASIS HOME HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBR
Authorized Official - Prefix:MS
Authorized Official - First Name:FATMATA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-277-6003
Mailing Address - Street 1:98 JENNIFER LN
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-1142
Mailing Address - Country:US
Mailing Address - Phone:571-277-6003
Mailing Address - Fax:
Practice Address - Street 1:70 GRAMERCY LN
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-3322
Practice Address - Country:US
Practice Address - Phone:571-277-6003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care