Provider Demographics
NPI:1003246968
Name:L&L DIVINE COMMUNITY SERVICES INC
Entity Type:Organization
Organization Name:L&L DIVINE COMMUNITY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY-HARDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-955-2588
Mailing Address - Street 1:PO BOX 77253
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32226-7253
Mailing Address - Country:US
Mailing Address - Phone:904-955-2588
Mailing Address - Fax:904-766-1370
Practice Address - Street 1:7605 LUEDERS AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208-3443
Practice Address - Country:US
Practice Address - Phone:904-955-2588
Practice Address - Fax:904-766-1370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL229302253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL689136596Medicaid