Provider Demographics
NPI:1568054633
Name:DIVINE ACCOMMODATIONS IN-HOME CARE SERVICES LLC.
Entity Type:Organization
Organization Name:DIVINE ACCOMMODATIONS IN-HOME CARE SERVICES LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMILA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:321-305-6566
Mailing Address - Street 1:2110 W KING ST # 4B
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32926-5100
Mailing Address - Country:US
Mailing Address - Phone:321-305-6566
Mailing Address - Fax:321-305-5215
Practice Address - Street 1:2110 W KING ST # 4B
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32926-5100
Practice Address - Country:US
Practice Address - Phone:321-305-6566
Practice Address - Fax:321-305-5215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health