Healthcare Provider Details

I. General information

NPI: 1912844150
Provider Name (Legal Business Name): AJ DIVINE HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 TECH DATA DR FL 2 SUITE 2035
CLEARWATER FL
33760-3133
US

IV. Provider business mailing address

5225 TECH DATA DR FL 2
CLEARWATER FL
33760-3133
US

V. Phone/Fax

Practice location:
  • Phone: 515-473-8830
  • Fax:
Mailing address:
  • Phone: 515-473-8830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JANEAN MARIE POWELL
Title or Position: OWNER
Credential: RN, BSN
Phone: 515-473-8830