Divine Healthcare Services
NPI #1982999090 in Brown Deer, Wisconsin
Provider Information
- NPI Number
- 1982999090
- Entity Type
- Organization
- Organization Name
- Divine Healthcare Services
- Primary Specialty
- Nursing Facility/Intermediate Care Facility
- Enumeration Date
- Jun 16, 2011
- Last Updated
- Jun 16, 2011
Practice Location
- Address
- 4238 W HAWTHORNE TRACE RD APT 104
- City
- Brown Deer
- State
- Wisconsin
- ZIP Code
- 53209-1026
- Phone
- (414) 975-0121
Authorized Official
- Name
- GOLD OMEREONYE
- Title
- OWNER
- Phone
- (414) 975-0121
Specialties & Taxonomy Codes
| Specialty |
|---|
| Nursing Facility/Intermediate Care Facility |
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