Provider Demographics
NPI:1407366685
Name:DIVINE HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:DIVINE HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:DEBRA
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:360-747-7716
Mailing Address - Street 1:1118 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2222
Mailing Address - Country:US
Mailing Address - Phone:360-747-7716
Mailing Address - Fax:
Practice Address - Street 1:4555 NE 66TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3181
Practice Address - Country:US
Practice Address - Phone:360-314-2561
Practice Address - Fax:360-314-2943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health