Healthcare Provider Details

I. General information

NPI: 1336885516
Provider Name (Legal Business Name): DYVINE CARING AIDEZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 CENTRAL AVE STE 410
HOT SPRINGS AR
71901-5351
US

IV. Provider business mailing address

835 CENTRAL AVE STE 410
HOT SPRINGS AR
71901-5351
US

V. Phone/Fax

Practice location:
  • Phone: 501-701-4239
  • Fax:
Mailing address:
  • Phone: 501-701-4239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: LUEVERSIE GORDEN
Title or Position: PARTNER
Credential:
Phone: 501-617-6269