Provider Demographics
NPI:1821487950
Name:EL & DIVINE HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:EL & DIVINE HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/ OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADUSEI-POKU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-987-5052
Mailing Address - Street 1:3330 BOURBON ST STE 108
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-7333
Mailing Address - Country:US
Mailing Address - Phone:540-689-0333
Mailing Address - Fax:540-689-0333
Practice Address - Street 1:3330 BOURBON ST STE 108
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-7333
Practice Address - Country:US
Practice Address - Phone:540-689-0333
Practice Address - Fax:540-689-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-151153251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health