Provider Demographics
NPI:1639435977
Name:DIVINE HOME HEALTH CARE AGENCY
Entity Type:Organization
Organization Name:DIVINE HOME HEALTH CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KWABENA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DODI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-965-3970
Mailing Address - Street 1:325 E BAYVIEW BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-5200
Mailing Address - Country:US
Mailing Address - Phone:757-965-3970
Mailing Address - Fax:757-965-3971
Practice Address - Street 1:325 E BAYVIEW BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23503-5200
Practice Address - Country:US
Practice Address - Phone:757-713-0206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health