Provider Demographics
NPI:1811298854
Name:DIVINE HOME HEALTH SERVICES LLC
Entity type:Organization
Organization Name:DIVINE HOME HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:248-823-8772
Mailing Address - Street 1:2346 SAFFRON CT
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-6715
Mailing Address - Country:US
Mailing Address - Phone:248-823-8772
Mailing Address - Fax:248-823-5949
Practice Address - Street 1:2346 SAFFRON CT
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-6715
Practice Address - Country:US
Practice Address - Phone:248-823-8772
Practice Address - Fax:248-823-5949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014058225100000X
MI4704220571163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty