MEDICARE: DIVINE HEALING SUPPLIES

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	332BN1400X	Nursing Facility Supplies (DME)
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1548120264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE HEALING SUPPLIES

Provider Business Mailing Address
First Line	:	13465 MIDWAY ROAD SUITE 450
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-5204
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13465 MIDWAY RD STE 450
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75244-5204
Country	:	US
Telephone Number	:	214-489-7852
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JAQUISHA MARTIN
Credential	:
Telephone Number	:	214-489-7852

Provider Enumeration Date	:	11/14/2025
Last Update Date	:	02/18/2026

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Directions to “DIVINE HEALING SUPPLIES ” Practice Location

Language	Start Address	Practice Location

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