Provider Demographics
NPI:1275148405
Name:DIVINE FAITH, PRIMARY HOME CARE, LLC
Entity Type:Organization
Organization Name:DIVINE FAITH, PRIMARY HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-241-1503
Mailing Address - Street 1:30744 FM 510
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-9394
Mailing Address - Country:US
Mailing Address - Phone:956-241-1503
Mailing Address - Fax:
Practice Address - Street 1:30602 SAINT FRANCIS AVE
Practice Address - Street 2:
Practice Address - City:LOS FRESNOS
Practice Address - State:TX
Practice Address - Zip Code:78566-8331
Practice Address - Country:US
Practice Address - Phone:956-484-2233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-14
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty