Provider Demographics
NPI:1700066073
Name:DIVINE HANDS OF CARE, INC
Entity Type:Organization
Organization Name:DIVINE HANDS OF CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DARRISAW
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:772-528-6628
Mailing Address - Street 1:4140 WORLINGTON TER
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-1335
Mailing Address - Country:US
Mailing Address - Phone:772-528-6628
Mailing Address - Fax:772-466-4988
Practice Address - Street 1:4140 WORLINGTON TER
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-1335
Practice Address - Country:US
Practice Address - Phone:772-528-6628
Practice Address - Fax:772-466-4988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL688140896251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL688140898Medicaid
FL688140896Medicaid