Provider Demographics
NPI:1881437812
Name:DIVINE RELIANCE HOME HEALTH AGENCY LLC
Entity type:Organization
Organization Name:DIVINE RELIANCE HOME HEALTH AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DIVINE
Authorized Official - Middle Name:TAMOBISONG
Authorized Official - Last Name:NKEMTOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-898-5549
Mailing Address - Street 1:3537 CATALPA VIEW WAY
Mailing Address - Street 2:
Mailing Address - City:BELLBROOK
Mailing Address - State:OH
Mailing Address - Zip Code:45305-7510
Mailing Address - Country:US
Mailing Address - Phone:240-898-5549
Mailing Address - Fax:
Practice Address - Street 1:3537 CATALPA VIEW WAY
Practice Address - Street 2:
Practice Address - City:BELLBROOK
Practice Address - State:OH
Practice Address - Zip Code:45305-7510
Practice Address - Country:US
Practice Address - Phone:240-898-5549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health