Provider Demographics
NPI:1306364492
Name:DIVINE HOME CARE SERVICES, LLC
Entity Type:Organization
Organization Name:DIVINE HOME CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNGAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-432-6621
Mailing Address - Street 1:639 S HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-3176
Mailing Address - Country:US
Mailing Address - Phone:614-432-6621
Mailing Address - Fax:
Practice Address - Street 1:639 S HAMILTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-3176
Practice Address - Country:US
Practice Address - Phone:614-432-6621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251F00000X, 251J00000X
OH253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care