Provider Demographics
NPI:1053615039
Name:DIVINE PROMISES NURSING AGENCY
Entity type:Organization
Organization Name:DIVINE PROMISES NURSING AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TITILOLA
Authorized Official - Middle Name:HARRIET
Authorized Official - Last Name:ADANRITAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:619-334-3438
Mailing Address - Street 1:1630 WALLY WAY
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-3684
Mailing Address - Country:US
Mailing Address - Phone:619-334-3438
Mailing Address - Fax:619-334-3438
Practice Address - Street 1:1630 WALLY WAY
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-3684
Practice Address - Country:US
Practice Address - Phone:619-334-3438
Practice Address - Fax:619-334-3438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 273Y00000X, 282E00000X, 283Q00000X, 310400000X
CA643553261QM0850X, 282N00000X, 283X00000X, 286500000X, 310400000X, 320700000X, 323P00000X, 324500000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No273Y00000XHospital UnitsRehabilitation Unit
No282E00000XHospitalsLong Term Care Hospital
No282N00000XHospitalsGeneral Acute Care Hospital
No283Q00000XHospitalsPsychiatric Hospital
No283X00000XHospitalsRehabilitation Hospital
No286500000XHospitalsMilitary Hospital
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No385H00000XRespite Care FacilityRespite Care