Healthcare Provider Details

I. General information

NPI: 1588362966
Provider Name (Legal Business Name): DIVINE AGAPE HEALTH CARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E ESPLANADE DR STE 1720
OXNARD CA
93036-0270
US

IV. Provider business mailing address

300 E ESPLANADE DR STE 1670
OXNARD CA
93036-0247
US

V. Phone/Fax

Practice location:
  • Phone: 805-603-4244
  • Fax:
Mailing address:
  • Phone:
  • Fax: 805-919-0074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. MAE BEVERLY DOMINGO
Title or Position: CEO
Credential:
Phone: 818-397-0757