Provider Demographics
NPI:1437829231
Name:DIVINE HOMECARE LLC
Entity Type:Organization
Organization Name:DIVINE HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JONITA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-403-3337
Mailing Address - Street 1:4991 E MCKINLEY AVE STE 117
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1966
Mailing Address - Country:US
Mailing Address - Phone:559-403-3337
Mailing Address - Fax:
Practice Address - Street 1:4991 E MCKINLEY AVE STE 117
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1966
Practice Address - Country:US
Practice Address - Phone:559-403-3337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care