MEDICARE: DIVINE HARVEST HOME CARE SERVICES, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	251J00000X	Nursing Care Agency
3	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1265396584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE HARVEST HOME CARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	2605 CORNWALL DR
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-6875
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2605 CORNWALL DR
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-6875
Country	:	US
Telephone Number	:	678-544-9234
Fax Number	:	678-759-1775

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	YOLANDA HARRIS
Credential	:
Telephone Number	:	678-544-9234

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	12/11/2025

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