Provider Demographics
NPI:1679258719
Name:DIVINE HEALTH AND WELLNESS HOME CARE LLC
Entity Type:Organization
Organization Name:DIVINE HEALTH AND WELLNESS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:704-970-7998
Mailing Address - Street 1:165 MAHALEY AVE STE 1060
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2448
Mailing Address - Country:US
Mailing Address - Phone:704-970-7998
Mailing Address - Fax:980-330-5020
Practice Address - Street 1:165 MAHALEY AVE STE 1060
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2448
Practice Address - Country:US
Practice Address - Phone:704-970-7998
Practice Address - Fax:980-330-5020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health