Organization
DIVINE SUPPORTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MILLICENT IWUCHUKWU DR. (CEO)
(615) 594-7139
Entity
Organization
Contact information
Practice address
2131 MURFREESBORO PIKE STE 211, NASHVILLE, TN 37217-6316
(615) 432-2917
Mailing address
2131 MURFREESBORO PIKE STE 211, NASHVILLE, TN 37217-6316
(615) 432-2917
(615) 250-4772
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05727485
AMERIGROUP
—
Enumeration date
12/18/2018
Last updated
12/18/2018
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