Provider Demographics
NPI:1437967767
Name:DIVINE HOMES HEALTHCARE SERVICES
Entity type:Organization
Organization Name:DIVINE HOMES HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IDOWU
Authorized Official - Middle Name:
Authorized Official - Last Name:OLATEJU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-696-9303
Mailing Address - Street 1:15103 ROVING WOOD DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-3373
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15103 ROVING WOOD DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-3373
Practice Address - Country:US
Practice Address - Phone:240-696-9303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities