Provider Demographics
NPI:1952602849
Name:DHC DIVINE HEALTH CARE, LLC
Entity Type:Organization
Organization Name:DHC DIVINE HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:956-563-7509
Mailing Address - Street 1:4309 NORTH 10TH STREET
Mailing Address - Street 2:STE. C
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504
Mailing Address - Country:US
Mailing Address - Phone:956-563-7509
Mailing Address - Fax:956-687-7509
Practice Address - Street 1:4309 NORTH 10TH STREET
Practice Address - Street 2:STE. C
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504
Practice Address - Country:US
Practice Address - Phone:956-563-7509
Practice Address - Fax:956-687-7509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-08
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX013812251E00000X
3747A0650X, 3747P1801X, 405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX74-7735Medicare UPIN