Provider Demographics
NPI:1497887327
Name:DIVINITY HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:DIVINITY HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:WILMA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:313-690-7456
Mailing Address - Street 1:30685 BARRINGTON ST
Mailing Address - Street 2:SUITE 125
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-5111
Mailing Address - Country:US
Mailing Address - Phone:313-690-7456
Mailing Address - Fax:248-583-4233
Practice Address - Street 1:30685 BARRINGTON ST
Practice Address - Street 2:SUITE 125
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-5111
Practice Address - Country:US
Practice Address - Phone:248-583-2733
Practice Address - Fax:248-583-4233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health