Provider Demographics
NPI:1427598564
Name:D'VINE HOME CARE LLC
Entity Type:Organization
Organization Name:D'VINE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELE
Authorized Official - Middle Name:
Authorized Official - Last Name:HILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-237-2123
Mailing Address - Street 1:112 W WASHINGTON ST STE 602
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-5246
Mailing Address - Country:US
Mailing Address - Phone:757-539-0002
Mailing Address - Fax:757-529-0012
Practice Address - Street 1:112 W WASHINGTON ST STE 602
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-5246
Practice Address - Country:US
Practice Address - Phone:757-539-0002
Practice Address - Fax:757-529-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health