Provider Demographics
NPI:1336885516
Name:DYVINE CARING AIDEZ LLC
Entity Type:Organization
Organization Name:DYVINE CARING AIDEZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LUEVERSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-617-6269
Mailing Address - Street 1:835 CENTRAL AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-5351
Mailing Address - Country:US
Mailing Address - Phone:501-701-4239
Mailing Address - Fax:
Practice Address - Street 1:835 CENTRAL AVE STE 410
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-5351
Practice Address - Country:US
Practice Address - Phone:501-701-4239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR281226797Medicaid
AR281037732Medicaid
AR281123757Medicaid