Provider Demographics
NPI:1720854714
Name:DIVINE HEALTH HOME CARE LLC
Entity Type:Organization
Organization Name:DIVINE HEALTH HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:EWING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-898-8403
Mailing Address - Street 1:7907 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64138-1965
Mailing Address - Country:US
Mailing Address - Phone:816-898-8403
Mailing Address - Fax:816-491-2240
Practice Address - Street 1:7907 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64138-1965
Practice Address - Country:US
Practice Address - Phone:816-898-8403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health