Provider Demographics
NPI:1225523566
Name:DIVINE HEART HOME HEALTH & NURSING SERVICES
Entity Type:Organization
Organization Name:DIVINE HEART HOME HEALTH & NURSING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:IKEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-477-5982
Mailing Address - Street 1:3172 OMEGA DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-8815
Mailing Address - Country:US
Mailing Address - Phone:614-477-5982
Mailing Address - Fax:
Practice Address - Street 1:1110 MORSE RD STE 120B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-6325
Practice Address - Country:US
Practice Address - Phone:614-477-5982
Practice Address - Fax:614-882-6283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-100210164W00000X
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty