Provider Demographics
NPI:1093425993
Name:DIVINE INTENSIVE INC.
Entity Type:Organization
Organization Name:DIVINE INTENSIVE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARISMA
Authorized Official - Middle Name:UNIQUE
Authorized Official - Last Name:FUTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-940-0388
Mailing Address - Street 1:77 LUCINDA CT
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5770
Mailing Address - Country:US
Mailing Address - Phone:757-940-3888
Mailing Address - Fax:
Practice Address - Street 1:77 LUCINDA CT
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5770
Practice Address - Country:US
Practice Address - Phone:757-940-3888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care