Provider Demographics
NPI:1740946045
Name:DIVINE MIRACLES HOME CARE AGENCY
Entity type:Organization
Organization Name:DIVINE MIRACLES HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:YECENIA
Authorized Official - Middle Name:LUZ
Authorized Official - Last Name:PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:717-923-5030
Mailing Address - Street 1:2173 EMBASSY DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2387
Mailing Address - Country:US
Mailing Address - Phone:717-923-5030
Mailing Address - Fax:717-923-5031
Practice Address - Street 1:2173 EMBASSY DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2387
Practice Address - Country:US
Practice Address - Phone:717-923-5030
Practice Address - Fax:717-923-5031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health