Provider Demographics
NPI:1710284476
Name:DIVINE HOME CARE INC.
Entity Type:Organization
Organization Name:DIVINE HOME CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-468-1180
Mailing Address - Street 1:24613 UNION ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3150
Mailing Address - Country:US
Mailing Address - Phone:248-468-1180
Mailing Address - Fax:248-757-0443
Practice Address - Street 1:24613 UNION ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3150
Practice Address - Country:US
Practice Address - Phone:248-468-1180
Practice Address - Fax:248-757-0443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care