Divine Supports Services

Primary specialty

PACE Provider OrganizationTaxonomy code 251T00000X

License

RN600719 Issued in PA

Legal business name

DIVINE SUPPORTS SERVICES

Practice address

3954 Stratford Rd
Drexel Hill, PA 19026-2723

Phone

(484) 358-5535

NPI assigned

Nov 4, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Olufunmilayo Balogun-Victor, RN

Title

Ceo

Phone

(484) 358-5535

Specialties & licenses 2

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1478217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493769600000",
    "number": "1669924866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3954 STRATFORD RD",
            "city": "DREXEL HILL",
            "state": "PA",
            "postal_code": "190262723",
            "telephone_number": "484-358-5535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3954 STRATFORD RD",
            "city": "DREXEL HILL",
            "state": "PA",
            "postal_code": "190262723",
            "telephone_number": "484-358-5535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE SUPPORTS SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-04",
        "last_updated": "2017-05-03",
        "status": "A",
        "authorized_official_last_name": "BALOGUN-VICTOR",
        "authorized_official_first_name": "OLUFUNMILAYO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "484-358-5535",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "PA",
            "license": "RN600719",
            "primary": false
        },
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": "PA",
            "license": "RN600719",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ODP",
            "identifier": "103220771",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• PACE Provider Organization in Drexel Hill, PA
• Providers in Drexel Hill, PA by specialty
• PACE Provider Organization in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.