Provider Demographics
NPI:1760823272
Name:DIVINE HEARTS HOMECARE LLC
Entity Type:Organization
Organization Name:DIVINE HEARTS HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:864-283-1138
Mailing Address - Street 1:439 CONGAREE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2709
Mailing Address - Country:US
Mailing Address - Phone:864-283-1138
Mailing Address - Fax:
Practice Address - Street 1:439 CONGAREE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2709
Practice Address - Country:US
Practice Address - Phone:864-283-1138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care