| Divine Interventions | |
|
2089 Anita Ave Grosse Pointe Woods MI 48236-1427 | |
| (313) 459-6707 | |
| (313) 731-0360 |
| Full Name | Divine Interventions |
|---|---|
| Speciality | Clinic/Center |
| Location | 2089 Anita Ave, Grosse Pointe Woods, Michigan |
| Authorized Official Name and Position | Chontay Detria Taylor Glenn (FOUNDER AND CEO) |
| Authorized Official Contact | 3134596707 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Divine Interventions 2089 Anita Ave Grosse Pointe Woods MI 48236-1427 Ph: (313) 459-6707 | Divine Interventions 2089 Anita Ave Grosse Pointe Woods MI 48236-1427 Ph: (313) 459-6707 |
| NPI Number | 1407020993 |
|---|---|
| Provider Enumeration Date | 04/16/2008 |
| Last Update Date | 11/04/2022 |
| Certification Date | 11/04/2022 |
| Medicare PECOS PAC ID | 6709206790 |
|---|---|
| Medicare Enrollment ID | O20201013001249 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407020993 | NPI | - | NPPES |
| Provider Name | Chontay D Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164631727 PECOS PAC ID: 8325135635 Enrollment ID: I20130923000329 |
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