Healthcare Provider Details

I. General information

NPI: 1548689847
Provider Name (Legal Business Name): DIVINE HOME HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 E RAY RD STE 130
GILBERT AZ
85296-4206
US

IV. Provider business mailing address

4735 S SOUTHWIND DR
GILBERT AZ
85297-1973
US

V. Phone/Fax

Practice location:
  • Phone: 480-812-3680
  • Fax:
Mailing address:
  • Phone: 480-812-3680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: GLORIA ADJEI
Title or Position: DIR. OF NURSING
Credential: REGISTERED NURSE
Phone: 480-812-3680