MEDICARE: DIVINE LOVE ADULT 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1265396774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE LOVE ADULT CARE LLC

Provider Business Mailing Address
First Line	:	28860 SOUTHFIELD RD STE 202
Second Line	:
City	:	LATHRUP VILLAGE
State	:	MI
Zip	:	48076-2726
Country	:	US
Telephone Number	:	248-483-1130
Fax Number	:	248-483-1130

Provider Business Practice Location Address
First Line	:	28860 SOUTHFIELD RD STE 202
Second Line	:
City	:	LATHRUP VILLAGE
State	:	MI
Zip	:	48076-2726
Country	:	US
Telephone Number	:	248-483-1130
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	ERICKA SHANAE WILLIAMS
Credential	:	LPN
Telephone Number	:	248-483-1130

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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