Provider Demographics
NPI:1720358526
Name:DIVINE HOME CARE PROVIDERS, LLC
Entity Type:Organization
Organization Name:DIVINE HOME CARE PROVIDERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
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:757-833-0505
Mailing Address - Street 1:125 ALBERTA DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-6546
Mailing Address - Country:US
Mailing Address - Phone:757-833-0505
Mailing Address - Fax:757-833-0065
Practice Address - Street 1:125 ALBERTA DR
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-6546
Practice Address - Country:US
Practice Address - Phone:757-833-0505
Practice Address - Fax:757-833-0065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health