Provider Demographics
NPI:1629160239
Name:DEVINE HOME HEALTH AGENCY INC
Entity Type:Organization
Organization Name:DEVINE HOME HEALTH AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:EJOFOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-871-9152
Mailing Address - Street 1:800 W. AIRPORT FREEWAY
Mailing Address - Street 2:SUITE 514
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062
Mailing Address - Country:US
Mailing Address - Phone:972-871-9152
Mailing Address - Fax:972-871-9172
Practice Address - Street 1:800 W. AIRPORT FREEWAY
Practice Address - Street 2:SUITE 514
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062
Practice Address - Country:US
Practice Address - Phone:972-871-9152
Practice Address - Fax:972-871-9172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008474251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679453Medicare ID - Type Unspecified