Organization
DIVINE PROVIDENCE INC
Active
Other names
providence medical supply
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MODUPE IROROBEJE (CEO)
(702) 778-3072
Entity
Organization
Contact information
Practice address
1729 E CHARLESTON BLVD STE F, LAS VEGAS, NV 89104-1986
(954) 663-1759
Mailing address
11055 KILKERRAN CT, LAS VEGAS, NV 89141-4356
(954) 663-1759
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
04/06/2019
Last updated
04/06/2019
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