Provider Demographics
NPI:1558823658
Name:DIVINITY HOME HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:DIVINITY HOME HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARMA
Authorized Official - Middle Name:
Authorized Official - Last Name:LASKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-267-1007
Mailing Address - Street 1:1271 SUTTER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63133-1948
Mailing Address - Country:US
Mailing Address - Phone:314-267-1007
Mailing Address - Fax:
Practice Address - Street 1:1271 SUTTER AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63133-1948
Practice Address - Country:US
Practice Address - Phone:314-267-1007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health