MEDICARE: DIVINE CARE AT HOME

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1326769639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE CARE AT HOME

Provider Business Mailing Address
First Line	:	221 SAINT JAMES AVE STE 13A
Second Line	:
City	:	GOOSE CREEK
State	:	SC
Zip	:	29445-3270
Country	:	US
Telephone Number	:	843-793-2588
Fax Number	:	843-407-3036

Provider Business Practice Location Address
First Line	:	221 SAINT JAMES AVE STE 13A
Second Line	:
City	:	GOOSE CREEK
State	:	SC
Zip	:	29445-3270
Country	:	US
Telephone Number	:	843-793-2588
Fax Number	:	843-407-3036

Authorized Official
Title or Position	:	OWNER
Name	:	DANA SIMMONS
Credential	:
Telephone Number	:	843-793-2588

Provider Enumeration Date	:	09/06/2022
Last Update Date	:	09/06/2022

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Directions to “DIVINE CARE AT HOME ” Practice Location

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