National Provider Identifier Database

DIVINE HEALTHCARE SERVICES
Nursing Facility/Intermediate Care Facility

An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals.


Contact Information

DIVINE HEALTHCARE SERVICES
4238 W HAWTHORNE TRACE RD APT 104
BROWN DEER, WI53209-1026
Phone: 414-975-0121
Fax:
Website:
Specialty Taxonomy Code
* Nursing Facility/Intermediate Care Facility 313M00000X

* Indicates primary specialty

NPI Profile & details for DIVINE HEALTHCARE SERVICES

NPI Number 1982999090
Legal business name
LBN
DIVINE HEALTHCARE SERVICES
Authorized official GOLD OMEREONYE - (OWNER)
Entity Organization
Organization subpart No
Enumeration date 06/16/2011
Last updated 06/16/2011 - About 15 years ago
Sole proprietor1 Not specified
Identifiers
  • WI License #: 126208-30
  • TX Other: 271904077 IRS

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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