Provider Demographics
NPI:1588021422
Name:DIVINE HEALTH ACADEMY
Entity Type:Organization
Organization Name:DIVINE HEALTH ACADEMY
Other - Org Name:D&C HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:AFAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-448-0251
Mailing Address - Street 1:5633 MONROE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-5591
Mailing Address - Country:US
Mailing Address - Phone:704-566-2955
Mailing Address - Fax:704-566-2957
Practice Address - Street 1:2 1/2 E WARREN ST
Practice Address - Street 2:10
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-5355
Practice Address - Country:US
Practice Address - Phone:704-954-4436
Practice Address - Fax:704-512-0165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4484251B00000X, 251F00000X, 251J00000X, 251K00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No251K00000XAgenciesPublic Health or Welfare