Provider Demographics
NPI:1114334521
Name:DIVINE HEALTH CARE INC.
Entity Type:Organization
Organization Name:DIVINE HEALTH CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAIMANDA
Authorized Official - Middle Name:ORSINI
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:757-604-8863
Mailing Address - Street 1:13195 HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:VA
Mailing Address - Zip Code:23314-3338
Mailing Address - Country:US
Mailing Address - Phone:757-604-8863
Mailing Address - Fax:
Practice Address - Street 1:11838 ROCK LANDING DR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4232
Practice Address - Country:US
Practice Address - Phone:757-604-8863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care