Provider Demographics
NPI:1457127789
Name:DIVINITY HOME CARE LLC
Entity Type:Organization
Organization Name:DIVINITY HOME CARE LLC
Other - Org Name:DIVINITY HOME CARE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEXTER
Authorized Official - Middle Name:D
Authorized Official - Last Name:CROUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-945-3947
Mailing Address - Street 1:14872 BELLAMY CT
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-5545
Mailing Address - Country:US
Mailing Address - Phone:317-945-3947
Mailing Address - Fax:
Practice Address - Street 1:14872 BELLAMY CT
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-5545
Practice Address - Country:US
Practice Address - Phone:317-945-3947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-28
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health