1992058242 NPI number — DIVINE MOTHER LOVE HEALTH CARE SERVICES INC

Table of content: (NPI 1992058242)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992058242 NPI number — DIVINE MOTHER LOVE HEALTH CARE SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIVINE MOTHER LOVE HEALTH CARE SERVICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992058242
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8903 ALTAMONT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77074-2409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-534-1108
Provider Business Mailing Address Fax Number:
713-534-1203

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5373 W ALABAMA ST # 442
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77056-5930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
102-815-1541
Provider Business Practice Location Address Fax Number:
888-604-9472
Provider Enumeration Date:
10/24/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OGADI
Authorized Official First Name:
MIKE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
713-534-1108

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  010114 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)