Provider Demographics
NPI:1659612802
Name:DIVINE CARE HOMES LLC
Entity Type:Organization
Organization Name:DIVINE CARE HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-796-4147
Mailing Address - Street 1:5319 S SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67216-3246
Mailing Address - Country:US
Mailing Address - Phone:316-796-4147
Mailing Address - Fax:316-529-4510
Practice Address - Street 1:5319 S SPRUCE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67216-3246
Practice Address - Country:US
Practice Address - Phone:316-796-4147
Practice Address - Fax:316-529-4510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSB087195311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home