Provider Demographics
NPI:1689028490
Name:DIVINE HOME CARE SERVICES, LLC
Entity Type:Organization
Organization Name:DIVINE HOME CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DALITHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMALLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-768-6021
Mailing Address - Street 1:739 THIMBLE SHOALS BLVD
Mailing Address - Street 2:503
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-3562
Mailing Address - Country:US
Mailing Address - Phone:757-768-6021
Mailing Address - Fax:
Practice Address - Street 1:739 THIMBLE SHOALS BLVD
Practice Address - Street 2:503
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3562
Practice Address - Country:US
Practice Address - Phone:757-768-6021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty