Divine Light Care Home LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

DIVINE LIGHT CARE HOME LLC

Practice address

5105 Bancroft Dr
La Mesa, CA 91941-4204

Phone

(619) 769-4545

NPI assigned

Dec 15, 2023

Organization subpart

No

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

Authorized official

Name

Rogelio Diaz

Title

Licensee

Phone

(619) 769-4545

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1702598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702598400000",
    "number": "1861260119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5105 BANCROFT DR",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919414204",
            "telephone_number": "619-769-4545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5105 BANCROFT DR",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919414204",
            "telephone_number": "619-769-4545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE LIGHT CARE HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-15",
        "last_updated": "2023-12-15",
        "certification_date": "2023-12-15",
        "status": "A",
        "authorized_official_last_name": "DIAZ",
        "authorized_official_first_name": "ROGELIO",
        "authorized_official_title_or_position": "LICENSEE",
        "authorized_official_telephone_number": "619-769-4545"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in La Mesa, CA
• Providers in La Mesa, CA by specialty
• Assisted Living Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2023; 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.