Provider Demographics
NPI:1740907633
Name:DIVINE MERCY HOME HEALTHCARE LLC
Entity type:Organization
Organization Name:DIVINE MERCY HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:IBEZIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-603-4338
Mailing Address - Street 1:137 COMMERCE PARK DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8636
Mailing Address - Country:US
Mailing Address - Phone:614-603-4338
Mailing Address - Fax:
Practice Address - Street 1:137 COMMERCE PARK DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8636
Practice Address - Country:US
Practice Address - Phone:614-603-4338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty