1871128397 NPI number — EXECUTIVES GROUP DBA DIVINE TOUCH HOME CARE SEVICES

Table of content: (NPI 1871128397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871128397 NPI number — EXECUTIVES GROUP DBA DIVINE TOUCH HOME CARE SEVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXECUTIVES GROUP DBA DIVINE TOUCH HOME CARE SEVICES
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:
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:
1871128397
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39252 WINCHESTER RD STE 107-139
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURRIETA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92563-3509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-675-6564
Provider Business Mailing Address Fax Number:
619-324-7796

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
91-1077 KANELA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EWA BEACH
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96706-5957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-285-9826
Provider Business Practice Location Address Fax Number:
619-324-7796
Provider Enumeration Date:
03/04/2020

Additional Information

Authorized Official

Authorized Official Last Name:
ALFONSO
Authorized Official First Name:
LAARNI
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE OFFICER
Authorized Official Telephone Number:
808-675-6564

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com