Healthcare Provider Details

I. General information

NPI: 1649800723
Provider Name (Legal Business Name): DIVINE CHOICE HOME HEALTH AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 BEXLEY CT
DELAND FL
32720-0846
US

IV. Provider business mailing address

PO BOX 1013
DELAND FL
32721-1013
US

V. Phone/Fax

Practice location:
  • Phone: 386-215-4299
  • Fax:
Mailing address:
  • Phone: 386-215-4299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: FITZROY COULSON
Title or Position: CEO
Credential:
Phone: 386-873-2021