Provider Demographics
NPI:1225489487
Name:DIVINITY ADVANTAGE PERSONAL CARE
Entity Type:Organization
Organization Name:DIVINITY ADVANTAGE PERSONAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:K
Authorized Official - Last Name:DIVINITY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:601-885-2360
Mailing Address - Street 1:2387 WORRELL RD
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MS
Mailing Address - Zip Code:39175-9302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2387 WORRELL RD
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MS
Practice Address - Zip Code:39175-9302
Practice Address - Country:US
Practice Address - Phone:601-885-2360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health