Provider Demographics
NPI:1740597996
Name:DIVINE CARE HOME HEALTH AGENCY
Entity Type:Organization
Organization Name:DIVINE CARE HOME HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOLITA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:847-990-0893
Mailing Address - Street 1:281 N SEYMOUR AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-2300
Mailing Address - Country:US
Mailing Address - Phone:847-949-4104
Mailing Address - Fax:847-949-4116
Practice Address - Street 1:281 N SEYMOUR AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-2300
Practice Address - Country:US
Practice Address - Phone:847-949-4104
Practice Address - Fax:847-949-4116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1011246251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health