Divine Center, Inc

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

200400002C Issued in IL

Legal business name

DIVINE CENTER, INC

Practice address

8351 S Marquette Ave
Chicago, IL 60617-2022

Phone

(773) 721-6535

Fax

(773) 721-7065

NPI assigned

May 4, 2016

Last updated

May 4, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Samuel Ogunro

Title

President/Ceo(Operations)

Phone

(773) 721-6535

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1462320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462320000000",
    "number": "1831545268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8351 S MARQUETTE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606172022",
            "telephone_number": "773-721-6535",
            "fax_number": "773-721-7065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8351 S MARQUETTE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606172022",
            "telephone_number": "773-721-6535",
            "fax_number": "773-721-7065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-04",
        "last_updated": "2016-05-04",
        "status": "A",
        "authorized_official_last_name": "OGUNRO",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "PRESIDENT/CEO(OPERATIONS)",
        "authorized_official_telephone_number": "773-721-6535"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "IL",
            "license": "200400002C",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DHS DDD",
            "identifier": "7094638",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DHS DDD",
            "identifier": "3000006",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Chicago, IL
• Providers in Chicago, IL by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2016; 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.