Provider Demographics
NPI:1346726403
Name:DEVINE CARE HOME LLC
Entity Type:Organization
Organization Name:DEVINE CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:NDUKWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-526-0193
Mailing Address - Street 1:6019 ACORN VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-6241
Mailing Address - Country:US
Mailing Address - Phone:832-526-0193
Mailing Address - Fax:
Practice Address - Street 1:6019 ACORN VALLEY LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-6241
Practice Address - Country:US
Practice Address - Phone:832-526-0193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X, 253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092461OtherMEDICAID
TX092461OtherMEDICAID