Provider Demographics
NPI:1932745254
Name:DIVINE FAVOR HOME CARE AGENCY INC
Entity Type:Organization
Organization Name:DIVINE FAVOR HOME CARE AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:REZELL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSTON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:336-263-8431
Mailing Address - Street 1:3992 SHONNETTE DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-8665
Mailing Address - Country:US
Mailing Address - Phone:336-263-8431
Mailing Address - Fax:
Practice Address - Street 1:3992 SHONNETTE DR
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-8665
Practice Address - Country:US
Practice Address - Phone:336-263-8431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-21
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care