Provider Demographics
NPI:1922522499
Name:J&T DIVINE CARE
Entity Type:Organization
Organization Name:J&T DIVINE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TESICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-756-9492
Mailing Address - Street 1:440 ROYELLOU LN STE 205
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-5520
Mailing Address - Country:US
Mailing Address - Phone:407-756-9492
Mailing Address - Fax:352-729-2210
Practice Address - Street 1:440 ROYELLOU LN
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-5510
Practice Address - Country:US
Practice Address - Phone:352-729-2210
Practice Address - Fax:352-729-2210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-27
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL020680200251E00000X
251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021179400Medicaid
FL020680200Medicaid
FL109695900Medicaid