Organization
DIVINERESTORATIONHELTHCARE@YAHOO.COM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. OKAFOR THEODORE ONYAKA (OWNER)
(678) 314-4383
Entity
Organization
Contact information
Practice address
7736 PARKSIDE DR, LITHIA SPRINGS, GA 30122-6869
(678) 314-4383
Mailing address
7736 PARKSIDE DR, LITHIA SPRINGS, GA 30122-6869
(678) 314-4383
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
670280472
—
GA
Enumeration date
08/29/2021
Last updated
08/29/2021
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