MEDICARE: DIVINE ESSENCE ABUNDANCE HOME CARE 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
1	251C00000X	Developmentally Disabled Services Day Training Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700502630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE ESSENCE ABUNDANCE HOME CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	1811 N REYNOLDS RD STE 101A
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-3533
Country	:	US
Telephone Number	:	419-509-2867
Fax Number	:

Provider Business Practice Location Address
First Line	:	1811 NORTH REYNOLDS UNIT 101-A
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615
Country	:	US
Telephone Number	:	567-277-2729
Fax Number	:

Authorized Official
Title or Position	:	AGENCY OWNER/ DIRECTOR OF OPERATION
Name	:	JERRIKA S JACKSON
Credential	:
Telephone Number	:	418-509-2867

Provider Enumeration Date	:	10/12/2022
Last Update Date	:	04/14/2026

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