MEDICARE: DIVINE CARE HOME HEALTH, INC.

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	7890	OK

General Provider Information

NPI Number	:	1245481506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE CARE HOME HEALTH, INC.

Provider Business Mailing Address
First Line	:	6801 S WESTERN AVE STE 200
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-1816
Country	:	US
Telephone Number	:	405-635-9990
Fax Number	:

Provider Business Practice Location Address
First Line	:	6801 S WESTERN AVE STE 200
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-1816
Country	:	US
Telephone Number	:	405-635-9990
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR/OWNER
Name	:	MS. BLESSING NWOHA
Credential	:	RN
Telephone Number	:	405-635-9990

Provider Enumeration Date	:	10/06/2008
Last Update Date	:	04/17/2012

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