MEDICARE: DIVINE CONNECTIONS HOME CARE AGENCY

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		PA

General Provider Information

NPI Number	:	1588106470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE CONNECTIONS HOME CARE AGENCY

Provider Business Mailing Address
First Line	:	1729 S CLEVELAND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-2106
Country	:	US
Telephone Number	:	302-437-6622
Fax Number	:

Provider Business Practice Location Address
First Line	:	1729 S CLEVELAND ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19145-2106
Country	:	US
Telephone Number	:	302-437-6622
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. TYESHA N TILGHMAN-BERRY
Credential	:
Telephone Number	:	302-437-6622

Provider Enumeration Date	:	11/09/2016
Last Update Date	:	11/09/2016

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