Provider Demographics
NPI:1275892564
Name:DEBRA'S DIVINE CARE INC
Entity Type:Organization
Organization Name:DEBRA'S DIVINE CARE INC
Other - Org Name:DEBRA'S ASSISTED LIVING FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-546-4884
Mailing Address - Street 1:5608 KENNY DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-7711
Mailing Address - Country:US
Mailing Address - Phone:813-546-4884
Mailing Address - Fax:813-443-2814
Practice Address - Street 1:5608 KENNY DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-7711
Practice Address - Country:US
Practice Address - Phone:813-546-4884
Practice Address - Fax:813-443-2814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health