Organization
DIVINE CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL OGUNRO (PRESIDENT/CEO(OPERATIONS))
(773) 721-6535
Entity
Organization
Contact information
Practice address
8351 S MARQUETTE AVE, CHICAGO, IL 60617-2022
(773) 721-6535
(773) 721-7065
Mailing address
8351 S MARQUETTE AVE, CHICAGO, IL 60617-2022
(773) 721-6535
(773) 721-7065
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
200400002C
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3000006
DHS DDD
IL
01
—
7094638
DHS DDD
IL
Enumeration date
05/04/2016
Last updated
05/04/2016
Update your record
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