Provider Demographics
NPI:1679851380
Name:DIVINED HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:DIVINED HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AWATIF
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-539-8047
Mailing Address - Street 1:28592 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2961
Mailing Address - Country:US
Mailing Address - Phone:248-539-8047
Mailing Address - Fax:248-539-8045
Practice Address - Street 1:28592 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 360
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2961
Practice Address - Country:US
Practice Address - Phone:248-539-8047
Practice Address - Fax:248-539-8045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI239270Medicare Oscar/Certification