Organization
DIVINE LIGHT CARE HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROGELIO DIAZ (LICENSEE)
(619) 769-4545
Entity
Organization
Contact information
Practice address
5105 BANCROFT DR, LA MESA, CA 91941-4204
(619) 769-4545
Mailing address
5105 BANCROFT DR, LA MESA, CA 91941-4204
(619) 769-4545
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
12/15/2023
Last updated
12/15/2023
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