DIVINE HEALTHCARE SERVICES (NPI# 1982999090) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982999090 |
| Entity Type | Organization |
| Organization Name | DIVINE HEALTHCARE SERVICES |
| Practice Address |
4238 W Hawthorne Trace Rd Apt 104 Brown Deer WI 53209-1026 |
| Practice Telephone | 4149750121 |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2011-06-16 |
| Authorized Official Name | GOLD OMEREONYE (OWNER) |
| Authorized Official Telephone | 4149750121 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 313M00000X | Nursing Facility/Intermediate Care Facility | 126208-30 | WI | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | IRS | 271904077 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396303384 | Divine Healthcare Services | Home Health | 60 Evergreen Pl Ste 501, East Orange, NJ 07018-2118 | 2019-06-04 |
| 1881152619 | Divine Healthcare Services | Day Training, Developmentally Disabled Services | 8222 Northview Ct, Laurel, MD 20707-5880 | 2019-03-11 |
| 1952840415 | Divine Healthcare Services | Home Health | 60 Evergreen Pl, Suite 501, East Orange, NJ 07018-9992 | 2017-02-16 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | DIVINE HEALTHCARE SERVICES, LLC | 60 Evergreen Pl Ste 501, East Orange, NJ 07018-2118 |
| Colorado Business Entities | Divine Healthcare Services, ltd. | 2131 Hibbard Ln, Fountain, CO 80817 |
| Street Address |
4238 W HAWTHORNE TRACE RD APT 104 |
| City | BROWN DEER |
| State | WI |
| Zip Code | 53209-1026 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396032173 | Gold A Omereonye | Registered Nurse | 4238 W Hawthorne Trace Rd Apt 104, #104, Brown Deer, WI 53209-1026 | 2011-06-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780238253 | Niajcia Brookshire | Counselor | 3900 W Brown Deer Rd Suite 200, Brown Deer, WI 53209 | 2019-08-01 |
| 1740751015 | Mary Fuller | Home Health Aide | 3043 N 29th St., Milwaukee, WI 53209 | 2018-12-16 |
| 1154869410 | Jacksonscott2 | Skilled Nursing Facility | 4573 N. 22nd Street, Milwaukee, WI 53209 | 2017-02-07 |
| 1669910469 | Dimera House | In Home Supportive Care | 4002 W Fairount Ave, Milwaukee, WI 53209 | 2017-02-01 |
| 1891248340 | Amy L May | Nurse Practitioner | 3303 W Good Hope Rd, Milwaukee, WI 53209 | 2016-08-02 |
| 1871980193 | Alan R Rosenthal | Pharmacist | 6930 N Beech Tree Dr, Milwaukee, WI 53209 | 2015-04-24 |
| 1104212380 | Reema Shah | Student in an Organized Health Care Education/Training Program | 2400 W. Villard Ave, Milwaukee, WI 53209 | 2015-04-14 |
| 1336534403 | Robert Michael Kitsis | Family Medicine | 9252 N Green Bay Rd Fl 2, Brown Deer, WI 53209 | 2015-04-05 |
| 1962891994 | Kls Community Outreach Teen Center Consulting and Management L.L.C. | Public Health or Welfare | 8330 North Teutonia Ave Suite 103, Brown Deer, WI 53209 | 2015-01-14 |
| 1548659634 | Kls Community Outreach Teen Center Consulting and Management L.L.C. | Early Intervention Provider Agency | 8330 North Teutonia Avenue Suite 103, Brown Deer, WI 53209 | 2015-01-13 |
| Find all providers in zip 53209 | ||||
| Taxonomy Code | 313M00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Nursing Facility/Intermediate Care Facility |
| An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals. |
| Notes: Source: Paraphrased from Section 1919 (a) of the Social Security Act. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629504600 | North Oak Health Care, Inc. | Nursing Facility/Intermediate Care Facility | 1510 S 30th St, Manitowoc, WI 54220-5902 | 2017-05-11 |
| 1235685132 | Richard Hobin II | Nursing Facility/Intermediate Care Facility | 545 Hillcrest St, Viroqua, WI 54665-1750 | 2016-08-30 |
| 1154723955 | Amber Schmidt | Nursing Facility/Intermediate Care Facility | 113 Baehr St, Cecil, WI 54111-9204 | 2014-09-23 |
| 1184051047 | Amlang LLC | Nursing Facility/Intermediate Care Facility | 8303 Doe Glen Ct, Mount Pleasant, WI 53406-1756 | 2013-10-08 |
| 1427481480 | Madison College | Nursing Facility/Intermediate Care Facility | 1701 Wright St, Madison, WI 53704-2599 | 2013-08-14 |
| 1326310525 | Kate Droster | Nursing Facility/Intermediate Care Facility | 1227 Commonwealth Dr Apt 3, Fort Atkinson, WI 53538-3302 | 2012-02-02 |
| 1659640662 | Debra Jean Schwenn | Nursing Facility/Intermediate Care Facility | 2446 South 102nd Street Suite 340, Mj Care, Milwaukee, WI 53227 | 2011-12-20 |
| 1043501893 | Denise L Holterman | Nursing Facility/Intermediate Care Facility | 27334 Foxhaven Dr, Wind Lake, WI 53185-1978 | 2011-04-27 |
| 1083937759 | Va Health Care System (644) | Nursing Facility/Intermediate Care Facility | 911 Skyview Ave, Little Chute, WI 54140-2627 | 2010-03-09 |
| 1861661308 | Cedar Springs Health & Rehadilitation Center | Nursing Facility/Intermediate Care Facility | 961 Lamplighter Ln, Grafton, WI 53024-9314 | 2008-02-28 |
| Find all providers with the same taxonomy | ||||
| City | BROWN DEER |
| Zip Code | 53209 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.