MEDICARE: DEVINE HOME HEALTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1174217871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEVINE HOME HEALTH SERVICES

Provider Business Mailing Address
First Line	:	3592 BROADWAY STE 130
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-8056
Country	:	US
Telephone Number	:	727-401-1538
Fax Number	:

Provider Business Practice Location Address
First Line	:	3592 BROADWAY STE 130
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-8056
Country	:	US
Telephone Number	:	727-401-1538
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	YOLANDA NICOLE VALENTIN
Credential	:
Telephone Number	:	727-401-1538

Provider Enumeration Date	:	06/06/2023
Last Update Date	:	06/06/2023

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