Provider Demographics
NPI:1114501640
Name:A DEVINE INTERVENTION LLC
Entity Type:Organization
Organization Name:A DEVINE INTERVENTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-430-0218
Mailing Address - Street 1:301 CHASTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-4803
Mailing Address - Country:US
Mailing Address - Phone:727-430-0218
Mailing Address - Fax:
Practice Address - Street 1:1516 N 5TH ST UNIT 302C
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122-3677
Practice Address - Country:US
Practice Address - Phone:727-430-0218
Practice Address - Fax:813-324-9330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care