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NPI Code Detail

MEDICARE: DIVINE CARE NURSING SERVICES LLC

MEDICARE: DIVINE CARE NURSING SERVICES 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
1343900000XNon-emergency Medical Transport (VAN)
2251E00000XHome Health Agency
3253Z00000XIn Home Supportive Care Agency
4385H00000XRespite Care
5171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1356285712
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIVINE CARE NURSING SERVICES LLC
Provider Business Mailing Address
First Line : 6100 N 42ND ST STE 208
Second Line :
City : MILWAUKEE
State : WI
Zip : 53209-3560
Country : US
Telephone Number : 414-795-9761
Fax Number : 414-361-2447
Provider Business Practice Location Address
First Line : 6100 N 42ND ST STE 208
Second Line :
City : MILWAUKEE
State : WI
Zip : 53209-3560
Country : US
Telephone Number : 414-361-2363
Fax Number : 414-361-2447
Authorized Official
Title or Position : OWNER
Name : DESTINY C GREEN
Credential : RN
Telephone Number : 414-795-9761
Provider Enumeration Date : 04/16/2026
Last Update Date : 04/16/2026

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Directions to “DIVINE CARE NURSING SERVICES LLC ” Practice Location

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