Provider Demographics
NPI:1932655776
Name:DIVINE EXPECTATIONS
Entity Type:Organization
Organization Name:DIVINE EXPECTATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATRESS
Authorized Official - Middle Name:
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-758-5925
Mailing Address - Street 1:9620 SEAVIEW DR
Mailing Address - Street 2:UNIT 101
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-8020
Mailing Address - Country:US
Mailing Address - Phone:717-758-5925
Mailing Address - Fax:
Practice Address - Street 1:9620 SEAVIEW DR
Practice Address - Street 2:UNIT 101
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-8020
Practice Address - Country:US
Practice Address - Phone:717-758-5925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018760400Medicaid
FL234562OtherHOMEMAKER & COMPANION SERVICES