Provider Demographics
NPI:1245242171
Name:DIVINE HEALTH CARE SERVICES, INC.
Entity Type:Organization
Organization Name:DIVINE HEALTH CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HAJARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BABALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-595-2400
Mailing Address - Street 1:3200 BROADWAY BLVD STE 268
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-1572
Mailing Address - Country:US
Mailing Address - Phone:214-994-4915
Mailing Address - Fax:903-595-2415
Practice Address - Street 1:3200 BROADWAY BLVD STE 268
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-1572
Practice Address - Country:US
Practice Address - Phone:903-595-2400
Practice Address - Fax:903-595-2415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008313251E00000X
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679265Medicare Oscar/Certification