Provider Demographics
NPI:1770899767
Name:DIVINE HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:DIVINE HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ESMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-363-3056
Mailing Address - Street 1:PO BOX 1111
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38402-1111
Mailing Address - Country:US
Mailing Address - Phone:931-840-4119
Mailing Address - Fax:931-840-4121
Practice Address - Street 1:807 NASHVILLE HWY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-2418
Practice Address - Country:US
Practice Address - Phone:931-840-4119
Practice Address - Fax:931-840-4121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health