Provider Demographics
NPI:1669674305
Name:DIVINE HEALTH CARE CORP.
Entity Type:Organization
Organization Name:DIVINE HEALTH CARE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELOINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-541-3728
Mailing Address - Street 1:106 B SW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1429
Mailing Address - Country:US
Mailing Address - Phone:305-541-3728
Mailing Address - Fax:305-541-3729
Practice Address - Street 1:106 B SW 27TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1429
Practice Address - Country:US
Practice Address - Phone:305-541-3728
Practice Address - Fax:305-541-3729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA299992783251E00000X
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHHA299992783OtherAHCA LICENSE
FLHHA299992783OtherAHCA LICENSE