Provider Demographics
NPI:1598363418
Name:DIVINE HOME CARE LLC
Entity Type:Organization
Organization Name:DIVINE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:WELMA
Authorized Official - Middle Name:M
Authorized Official - Last Name:YALARTAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-279-6119
Mailing Address - Street 1:3523 45TH ST S STE 155
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8962
Mailing Address - Country:US
Mailing Address - Phone:469-279-6119
Mailing Address - Fax:
Practice Address - Street 1:1544 E GATEWAY CIR S APT 206
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3643
Practice Address - Country:US
Practice Address - Phone:469-279-6119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1477976OtherNON MEDICAL HOME CARE