Provider Demographics
NPI:1295323533
Name:DIVINITY HOMECARE LLC
Entity type:Organization
Organization Name:DIVINITY HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CANDIS
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-423-6795
Mailing Address - Street 1:8011 N POINT BLVD STE A-4
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3879
Mailing Address - Country:US
Mailing Address - Phone:336-999-7121
Mailing Address - Fax:
Practice Address - Street 1:8011 N POINT BLVD BLDG STE A-4
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3879
Practice Address - Country:US
Practice Address - Phone:336-999-7121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-04
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health