| Devine Behavioral Health Care | |
|
2304 Oak Ln Grand Prairie TX 75051-8812 | |
| (240) 543-0832 | |
| Not Available |
| Full Name | Devine Behavioral Health Care |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2304 Oak Ln, Grand Prairie, Texas |
| Authorized Official Name and Position | Adebukola Aderemi (NP) |
| Authorized Official Contact | 2405430832 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Devine Behavioral Health Care 2304 Oak Ln Grand Prairie TX 75051-8812 Ph: () - | Devine Behavioral Health Care 2304 Oak Ln Grand Prairie TX 75051-8812 Ph: (240) 543-0832 |
| NPI Number | 1275254765 |
|---|---|
| Provider Enumeration Date | 09/05/2022 |
| Last Update Date | 09/05/2022 |
| Certification Date | 09/04/2022 |
| Medicare PECOS PAC ID | 8123495504 |
|---|---|
| Medicare Enrollment ID | O20221028000876 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275254765 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Adebukola Aderemi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942842612 PECOS PAC ID: 1355760547 Enrollment ID: I20201008001041 |
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