Provider Demographics
NPI:1326769639
Name:DIVINE CARE AT HOME
Entity Type:Organization
Organization Name:DIVINE CARE AT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-793-2588
Mailing Address - Street 1:221 SAINT JAMES AVE STE 13A
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-3270
Mailing Address - Country:US
Mailing Address - Phone:843-793-2588
Mailing Address - Fax:843-407-3036
Practice Address - Street 1:221 SAINT JAMES AVE STE 13A
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-3270
Practice Address - Country:US
Practice Address - Phone:843-793-2588
Practice Address - Fax:843-407-3036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty