Provider Demographics
NPI:1356811210
Name:DIVINE HOME HEALTH, LLC
Entity type:Organization
Organization Name:DIVINE HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:CHIKE
Authorized Official - Last Name:OKEKE
Authorized Official - Suffix:
Authorized Official - Credentials:DIRECTOR
Authorized Official - Phone:317-918-7545
Mailing Address - Street 1:PO BOX 532491
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46253-2491
Mailing Address - Country:US
Mailing Address - Phone:317-918-7545
Mailing Address - Fax:
Practice Address - Street 1:4028 VILLAGE TRACE BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-6218
Practice Address - Country:US
Practice Address - Phone:317-918-7545
Practice Address - Fax:317-291-4351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty