Provider Demographics
NPI:1700047651
Name:DIVINE INSPIRATIONAL VIRTUOUS ANOINTED PERSONAL CARE SERVICE
Entity Type:Organization
Organization Name:DIVINE INSPIRATIONAL VIRTUOUS ANOINTED PERSONAL CARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAPHNE
Authorized Official - Middle Name:SHERELL
Authorized Official - Last Name:DAVIS-THEODORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-372-6457
Mailing Address - Street 1:11847 GREENMESA DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77044-7147
Mailing Address - Country:US
Mailing Address - Phone:713-240-6457
Mailing Address - Fax:
Practice Address - Street 1:11847 GREENMESA DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044-7147
Practice Address - Country:US
Practice Address - Phone:713-240-6457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA10072180251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health