Provider Demographics
NPI:1912666462
Name:DIVINE HUMANITY HOMECARE LLC.
Entity Type:Organization
Organization Name:DIVINE HUMANITY HOMECARE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
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 1:841 PRUDENTIAL DR FL 12
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8874
Mailing Address - Country:US
Mailing Address - Phone:904-333-3709
Mailing Address - Fax:
Practice Address - Street 1:841 PRUDENTIAL DR FL 12
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8874
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:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty