NPIMap

Organization Active NPI

Divine Healthcare Services

  • Nursing Facility/Intermediate Care Facility
  • Brown Deer, WI
National Provider Identifier
1982999090
Registry record updated Jun 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
126208-30 Issued in WI
Legal business name
DIVINE HEALTHCARE SERVICES
Practice address
4238 W Hawthorne Trace Rd Apt 104
Brown Deer, WI 53209-1026
Phone
(414) 975-0121
NPI assigned
Jun 16, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2011

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

Authorized official

Name
Gold OmereonyeNPI 1396032173
Title
Owner
Phone
(414) 975-0121

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 126208-30 WI Primary

Addresses

Primary practice location

4238 W Hawthorne Trace Rd Apt 104
Brown Deer, WI 53209-1026

Mailing address

4238 W Hawthorne Trace Rd Apt 104
Brown Deer, WI 53209-1026

Other identifiers 1

IdentifierTypeStateIssuer
271904077OtherTXIRS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1308182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308182400000",
    "number": "1982999090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4238 W HAWTHORNE TRACE RD APT 104",
            "city": "BROWN DEER",
            "state": "WI",
            "postal_code": "532091026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4238 W HAWTHORNE TRACE RD APT 104",
            "city": "BROWN DEER",
            "state": "WI",
            "postal_code": "532091026",
            "telephone_number": "414-975-0121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE HEALTHCARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-16",
        "last_updated": "2011-06-16",
        "status": "A",
        "authorized_official_last_name": "OMEREONYE",
        "authorized_official_first_name": "GOLD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-975-0121"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "WI",
            "license": "126208-30",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IRS",
            "identifier": "271904077",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brown Deer, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2011; 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.