MEDICARE: DIVINE 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	:	1215177332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	3375 VALLEY PARK AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-6123
Country	:	US
Telephone Number	:	614-432-6620
Fax Number	:	614-470-9676

Provider Business Practice Location Address
First Line	:	3375 VALLEY PARK AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-6123
Country	:	US
Telephone Number	:	614-432-6620
Fax Number	:	614-470-9676

Authorized Official
Title or Position	:	DIRECTOR OF NURSING
Name	:	MARY W MUCHENE
Credential	:	RN, BSN
Telephone Number	:	614-432-6620

Provider Enumeration Date	:	03/02/2009
Last Update Date	:	03/02/2009

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