Provider Demographics
NPI:1689374878
Name:DIVINE INTERVENTION HOME CARE AGENCY LLC
Entity Type:Organization
Organization Name:DIVINE INTERVENTION HOME CARE AGENCY LLC
Other - Org Name:DIVINE INTERVENTION WORLD WHOLISTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:R
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-598-8882
Mailing Address - Street 1:3035 DIRECTORS ROW STE 320
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38131-0420
Mailing Address - Country:US
Mailing Address - Phone:901-598-8882
Mailing Address - Fax:
Practice Address - Street 1:3035 DIRECTORS ROW STE 320
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38131-0420
Practice Address - Country:US
Practice Address - Phone:901-598-8882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care