Healthcare Provider Details

I. General information

NPI: 1831894344
Provider Name (Legal Business Name): DIVINE HOLY HOMEHEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22030 MAIN ST STE 103
CARSON CA
90745-2943
US

IV. Provider business mailing address

22030 MAIN ST STE 103
CARSON CA
90745-2943
US

V. Phone/Fax

Practice location:
  • Phone: 424-448-3928
  • Fax:
Mailing address:
  • Phone: 424-448-3928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ELEANOR VALDEZ
Title or Position: OWNER
Credential:
Phone: 434-448-3938