Provider Demographics
NPI:1770377657
Name:DIVINE CARE LIFE SERVICE
Entity type:Organization
Organization Name:DIVINE CARE LIFE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DEONNA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LIGONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-313-1176
Mailing Address - Street 1:4607 LIBRARY ROAD 220
Mailing Address - Street 2:867
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102
Mailing Address - Country:US
Mailing Address - Phone:412-313-1176
Mailing Address - Fax:
Practice Address - Street 1:301 S 4TH ST
Practice Address - Street 2:
Practice Address - City:DUQUESNE
Practice Address - State:PA
Practice Address - Zip Code:15110-1239
Practice Address - Country:US
Practice Address - Phone:412-313-1176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health