MEDICARE: DIVINITY CARES INCORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	251E00000X	Home Health Agency	LA
2	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care	LA
3	251G00000X	Community Based Hospice Care Agency	LA
4	253Z00000X	In Home Supportive Care Agency	LA
5	302F00000X	Exclusive Provider Organization	LA
6	332B00000X	Durable Medical Equipment & Medical Supplies	LA
7	332BC3200X	Customized Equipment (DME)	LA
8	332BD1200X	Dialysis Equipment & Supplies (DME)	LA
9	332BX2000X	Oxygen Equipment & Supplies (DME)	LA
10	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)	LA

General Provider Information

NPI Number	:	1942512165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINITY CARES INCORPORATION

Provider Business Mailing Address
First Line	:	1605 BROAD ST STE 16
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-4602
Country	:	US
Telephone Number	:	337-497-1871
Fax Number	:	337-497-1876

Provider Business Practice Location Address
First Line	:	1605 BROAD ST
Second Line	:	SUITE 16
City	:	LAKE CHARLES
State	:	LA
Zip	:	70601-4602
Country	:	US
Telephone Number	:	337-497-1871
Fax Number	:	337-497-1876

Authorized Official
Title or Position	:	CEO/FOUNDER
Name	:	MS. EDWINA HARMON BUSHNELL
Credential	:
Telephone Number	:	337-497-1871

Provider Enumeration Date	:	07/02/2010
Last Update Date	:	11/02/2010

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Directions to “DIVINITY CARES INCORPORATION ” Practice Location

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