Provider Demographics
NPI:1548586191
Name:DIVINE CARE LLC
Entity Type:Organization
Organization Name:DIVINE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FENTEZIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEWDIE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:612-423-9765
Mailing Address - Street 1:16125 HYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-8883
Mailing Address - Country:US
Mailing Address - Phone:612-423-9765
Mailing Address - Fax:952-236-9202
Practice Address - Street 1:16125 HYLAND AVE
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-8883
Practice Address - Country:US
Practice Address - Phone:612-423-9765
Practice Address - Fax:952-236-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN376844251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care