Provider Demographics
NPI:1871128397
Name:EXECUTIVES GROUP DBA DIVINE TOUCH HOME CARE SEVICES
Entity type:Organization
Organization Name:EXECUTIVES GROUP DBA DIVINE TOUCH HOME CARE SEVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LAARNI
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFONSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-675-6564
Mailing Address - Street 1:39252 WINCHESTER RD STE 107-139
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-3509
Mailing Address - Country:US
Mailing Address - Phone:808-675-6564
Mailing Address - Fax:619-324-7796
Practice Address - Street 1:91-1077 KANELA ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-5957
Practice Address - Country:US
Practice Address - Phone:808-285-9826
Practice Address - Fax:619-324-7796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care