| Divine Care Consultant Llc | |
|
6 Lilac Ln Bordentown NJ 08505-4821 | |
| (201) 693-7798 | |
| Not Available |
| Full Name | Divine Care Consultant Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6 Lilac Ln, Bordentown, New Jersey |
| Authorized Official Name and Position | Isata Bah (PROVIDER) |
| Authorized Official Contact | 2016937798 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Divine Care Consultant Llc 6 Lilac Ln Bordentown NJ 08505-4821 Ph: () - | Divine Care Consultant Llc 6 Lilac Ln Bordentown NJ 08505-4821 Ph: (201) 693-7798 |
| NPI Number | 1700654274 |
|---|---|
| Provider Enumeration Date | 12/14/2023 |
| Last Update Date | 12/14/2023 |
| Certification Date | 12/14/2023 |
| Medicare PECOS PAC ID | 8628413945 |
|---|---|
| Medicare Enrollment ID | O20240227001027 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700654274 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Isata F Bah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588260897 PECOS PAC ID: 9133510258 Enrollment ID: I20211229000042 |
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