Provider Demographics
NPI:1619049079
Name:DIVINE HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:DIVINE HOME HEALTH CARE LLC
Other - Org Name:ENLIVEN HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-517-3700
Mailing Address - Street 1:110 HAVERHILL RD STE 401
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-2121
Mailing Address - Country:US
Mailing Address - Phone:978-517-3700
Mailing Address - Fax:
Practice Address - Street 1:110 HAVERHILL RD STE 401
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913
Practice Address - Country:US
Practice Address - Phone:978-517-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA227501Medicare Oscar/Certification