Provider Demographics
NPI:1548615065
Name:DIVINE HOME HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:DIVINE HOME HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNGAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-860-1072
Mailing Address - Street 1:8080 BECKETT CENTER DR
Mailing Address - Street 2:SUITE 128
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-5026
Mailing Address - Country:US
Mailing Address - Phone:513-860-1072
Mailing Address - Fax:614-523-1600
Practice Address - Street 1:8080 BECKETT CENTER DR
Practice Address - Street 2:SUITE 128
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-5026
Practice Address - Country:US
Practice Address - Phone:513-860-1072
Practice Address - Fax:614-523-1600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health