MEDICARE: DIVINE TOUCH HOME HEALTH CARE LLC

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	:	1174407340
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE TOUCH HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	3104 TYRE NECK RD STE 203
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23703-4512
Country	:	US
Telephone Number	:	757-880-3106
Fax Number	:	948-212-3201

Provider Business Practice Location Address
First Line	:	3104 TYRE NECK RD STE 203
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23703-4512
Country	:	US
Telephone Number	:	757-880-3106
Fax Number	:	948-212-3201

Authorized Official
Title or Position	:	OWNER
Name	:	KIM MASON
Credential	:
Telephone Number	:	757-880-3106

Provider Enumeration Date	:	08/01/2025
Last Update Date	:	08/01/2025

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