Organization
DIVINE SUPPORTS SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLUFUNMILAYO BALOGUN-VICTOR RN (CEO)
(484) 358-5535
Entity
Organization
Contact information
Practice address
3954 STRATFORD RD, DREXEL HILL, PA 19026-2723
(484) 358-5535
Mailing address
3954 STRATFORD RD, DREXEL HILL, PA 19026-2723
(484) 358-5535
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
RN600719
PA
251T00000X
PACE Provider Organization
Primary
RN600719
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103220771
ODP
PA
Enumeration date
11/04/2016
Last updated
05/03/2017
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