Provider Demographics
NPI:1831856400
Name:DIVINE CARE HC LLC
Entity type:Organization
Organization Name:DIVINE CARE HC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:804-731-8584
Mailing Address - Street 1:304B NEW ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23868-1608
Mailing Address - Country:US
Mailing Address - Phone:804-731-8584
Mailing Address - Fax:
Practice Address - Street 1:304B NEW ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:VA
Practice Address - Zip Code:23868-1608
Practice Address - Country:US
Practice Address - Phone:804-731-8584
Practice Address - Fax:434-848-2659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health