Provider Demographics
NPI:1720699507
Name:DIVINE GRACE HOME CARE INC
Entity Type:Organization
Organization Name:DIVINE GRACE HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADEBOWALE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ADENIRAN
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:972-408-6033
Mailing Address - Street 1:3120 LONGBOW DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-7504
Mailing Address - Country:US
Mailing Address - Phone:972-408-6033
Mailing Address - Fax:
Practice Address - Street 1:601 S GREAT SOUTHWEST PKWY STE 103
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-1057
Practice Address - Country:US
Practice Address - Phone:972-408-6033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health