Provider Demographics
NPI:1942512165
Name:DIVINITY CARES INCORPORATION
Entity Type:Organization
Organization Name:DIVINITY CARES INCORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:EDWINA
Authorized Official - Middle Name:HARMON
Authorized Official - Last Name:BUSHNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-497-1871
Mailing Address - Street 1:1605 BROAD ST STE 16
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-4602
Mailing Address - Country:US
Mailing Address - Phone:337-497-1871
Mailing Address - Fax:337-497-1876
Practice Address - Street 1:1605 BROAD ST
Practice Address - Street 2:SUITE 16
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-4602
Practice Address - Country:US
Practice Address - Phone:337-497-1871
Practice Address - Fax:337-497-1876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA251E00000X, 251G00000X, 253Z00000X, 261QR0401X, 302F00000X, 332B00000X, 332BC3200X, 332BD1200X, 332BX2000X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No253Z00000XAgenciesIn Home Supportive Care
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child