Provider Demographics
NPI:1245008739
Name:DIVINELY PURPOSED CARE LLC
Entity type:Organization
Organization Name:DIVINELY PURPOSED CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRIS
Authorized Official - Middle Name:ANTON
Authorized Official - Last Name:VICKERS
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:407-283-9855
Mailing Address - Street 1:831 OAKLEY SEAVER DR APT 410
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-1990
Mailing Address - Country:US
Mailing Address - Phone:407-283-9855
Mailing Address - Fax:
Practice Address - Street 1:255 S ORANGE AVE STE 104
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-3411
Practice Address - Country:US
Practice Address - Phone:407-283-9855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care