MEDICARE: DIVINE LIGHT HOME HEALTH SERVICES

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

General Provider Information

NPI Number	:	1760273866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE LIGHT HOME HEALTH SERVICES

Provider Business Mailing Address
First Line	:	2363 ALBANY WAY
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20603-3800
Country	:	US
Telephone Number	:	202-710-6011
Fax Number	:

Provider Business Practice Location Address
First Line	:	2363 ALBANY WAY
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20603-3800
Country	:	US
Telephone Number	:	202-710-6011
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	EFFIONG WILLIE
Credential	:
Telephone Number	:	202-710-6011

Provider Enumeration Date	:	05/16/2025
Last Update Date	:	05/16/2025

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