Provider Demographics
NPI:1801224084
Name:DIVINITY HOME HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:DIVINITY HOME HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-491-4988
Mailing Address - Street 1:200 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-3426
Mailing Address - Country:US
Mailing Address - Phone:985-637-7507
Mailing Address - Fax:985-262-0058
Practice Address - Street 1:200 E 6TH ST
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-3426
Practice Address - Country:US
Practice Address - Phone:985-637-7507
Practice Address - Fax:985-262-0058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-24
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health