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	:	1265883995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	2206 EXECUTIVE DR
Second Line	:	SUITE A
City	:	HAMPTON
State	:	VA
Zip	:	23666-2583
Country	:	US
Telephone Number	:	757-224-7124
Fax Number	:

Provider Business Practice Location Address
First Line	:	2206 EXECUTIVE DR
Second Line	:	SUITE A
City	:	HAMPTON
State	:	VA
Zip	:	23666-2583
Country	:	US
Telephone Number	:	757-224-7124
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RAIMANDA THOMPSON
Credential	:
Telephone Number	:	757-604-8863

Provider Enumeration Date	:	06/23/2016
Last Update Date	:	06/23/2016

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Directions to “DIVINE HOME HEALTH CARE LLC ” Practice Location

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