Provider Demographics
NPI:1578863817
Name:DIVINE VISION SUPPORT SERVICES, INC.
Entity Type:Organization
Organization Name:DIVINE VISION SUPPORT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-398-7645
Mailing Address - Street 1:1010 E ADAMS ST
Mailing Address - Street 2:227
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202
Mailing Address - Country:US
Mailing Address - Phone:904-396-6745
Mailing Address - Fax:888-398-0944
Practice Address - Street 1:1010 E ADAMS ST
Practice Address - Street 2:227
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-1902
Practice Address - Country:US
Practice Address - Phone:904-396-6745
Practice Address - Fax:888-398-0944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1000014359251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL688070398Medicaid
FL688070396Medicaid