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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 Specialty Code Provider Type

Nursing Facility/Intermediate Care Facility

313M00000X A3[10] Other Nursing Facility
Indicates primary specialty

NPI Profile & details for DIVINE HEALTHCARE SERVICES

NPI Number 1982999090
LBN Legal business name DIVINE HEALTHCARE SERVICES
Authorized official GOLD OMEREONYE - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 06/16/2011
Last updated 06/16/2011 - About 15 years ago
Identifiers
WI License # 126208-30
TX Other 271904077 IRS
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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