Provider Demographics
NPI:1912520529
Name:DIVINE HUMANITY HEALTH LLC
Entity Type:Organization
Organization Name:DIVINE HUMANITY HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:ANDREA
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:904-333-3709
Mailing Address - Street 1:5415 ENCHANTED DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-1537
Mailing Address - Country:US
Mailing Address - Phone:904-333-3709
Mailing Address - Fax:
Practice Address - Street 1:8131 BAYMEADOWS CIR W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-2012
Practice Address - Country:US
Practice Address - Phone:904-333-3709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty