Organization
DIVINE PRIVATE HOME CARE PROVIDER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS LATIFAT ABIMBOLA OKE BACHELOR IN NURSING (ADMINISTRATOR)
(678) 517-5305
Entity
Organization
Contact information
Practice address
7317 DEXTER DR, RIVERDALE, GA 30296-1522
(678) 517-5305
Mailing address
7317 DEXTER DR, RIVERDALE, GA 30296-1522
(678) 517-5305
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
031-R-1124
GA
Other
Enumeration date
02/02/2015
Last updated
02/02/2015
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