Provider Demographics
NPI:1609447143
Name:DIVINE KEEPERS HOMECARE SERVICES LLC
Entity Type:Organization
Organization Name:DIVINE KEEPERS HOMECARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TURKESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-333-0213
Mailing Address - Street 1:103 TAPPAN ZEE DR
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-9440
Mailing Address - Country:US
Mailing Address - Phone:843-333-0213
Mailing Address - Fax:
Practice Address - Street 1:103 TAPPAN ZEE DR
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-9440
Practice Address - Country:US
Practice Address - Phone:843-333-0213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-06
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care