MEDICARE: DIVINITY HOMECARE 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
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1295323533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINITY HOMECARE LLC

Provider Business Mailing Address
First Line	:	8011 N POINT BLVD STE A-4
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-3879
Country	:	US
Telephone Number	:	336-999-7121
Fax Number	:

Provider Business Practice Location Address
First Line	:	8011 N POINT BLVD BLDG STE A-4
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-3879
Country	:	US
Telephone Number	:	336-999-7121
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CANDIS RENEE MCCARTHY
Credential	:
Telephone Number	:	336-423-6795

Provider Enumeration Date	:	01/04/2021
Last Update Date	:	03/20/2021

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