Provider Demographics
NPI:1073798310
Name:DIVINE GRACE HOME HEALTH INC.
Entity Type:Organization
Organization Name:DIVINE GRACE HOME HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO(PRESIDENT)
Authorized Official - Prefix:MR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:AFTAB
Authorized Official - Last Name:HUSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-956-5872
Mailing Address - Street 1:512 E WILSON AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4351
Mailing Address - Country:US
Mailing Address - Phone:818-956-5872
Mailing Address - Fax:818-956-5314
Practice Address - Street 1:512 E WILSON AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4351
Practice Address - Country:US
Practice Address - Phone:818-956-5872
Practice Address - Fax:818-956-5314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-06
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA059264Medicare Oscar/Certification