Provider Demographics
NPI:1649957093
Name:DIVINE DESIGN HOME CARE SERVICES LL
Entity type:Organization
Organization Name:DIVINE DESIGN HOME CARE SERVICES LL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LASHUNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-499-2547
Mailing Address - Street 1:1572 GA 85 SUITE 510
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1572 GA 85 SUITE 510
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214
Practice Address - Country:US
Practice Address - Phone:770-703-3224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory