Provider Demographics
NPI:1629396437
Name:DIVINE HOME CARE INC.
Entity Type:Organization
Organization Name:DIVINE HOME CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERD NURSE BSN
Authorized Official - Phone:276-644-3120
Mailing Address - Street 1:111 COMMONWEATH AVENUE
Mailing Address - Street 2:SUITE100
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201
Mailing Address - Country:US
Mailing Address - Phone:276-644-3120
Mailing Address - Fax:276-644-3123
Practice Address - Street 1:111 COMMONWEALTH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3831
Practice Address - Country:US
Practice Address - Phone:276-644-3120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health