Provider Demographics
NPI:1306717061
Name:DIVINELY CHOSEN SERVICES
Entity type:Organization
Organization Name:DIVINELY CHOSEN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MR
Authorized Official - First Name:KEONDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PN5256124
Authorized Official - Phone:689-290-6060
Mailing Address - Street 1:5252 HARTWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34785-7926
Mailing Address - Country:US
Mailing Address - Phone:689-290-6060
Mailing Address - Fax:
Practice Address - Street 1:3261 US 441
Practice Address - Street 2:SUITE B2
Practice Address - City:FRUITLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:34731
Practice Address - Country:US
Practice Address - Phone:689-290-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care