| Devine Providence Home Llc | |
|
3025 Blue Jay Ln Midlothian TX 76065-8705 | |
| (682) 375-3968 | |
| Not Available |
| Full Name | Devine Providence Home Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 3025 Blue Jay Ln, Midlothian, Texas |
| Authorized Official Name and Position | Cynthia Tuedjo Fegaing (DIRECTOR/MANAGER) |
| Authorized Official Contact | 6823753968 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Devine Providence Home Llc 3025 Blue Jay Ln Midlothian TX 76065-8705 Ph: (682) 375-3968 | Devine Providence Home Llc 3025 Blue Jay Ln Midlothian TX 76065-8705 Ph: (682) 375-3968 |
| NPI Number | 1588321343 |
|---|---|
| Provider Enumeration Date | 11/29/2021 |
| Last Update Date | 12/06/2021 |
| Certification Date | 12/06/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588321343 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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