Healthcare Provider Details

I. General information

NPI: 1831983972
Provider Name (Legal Business Name): DIVINE TRUCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

5700 LAKE WORTH RD STE 311-4
GREENACRES FL
33463-4727
US

IV. Provider business mailing address

5700 LAKE WORTH RD STE 311-4
GREENACRES FL
33463-4727
US

V. Phone/Fax

Practice location:
  • Phone: 561-954-9865
  • Fax:
Mailing address:
  • Phone: 561-954-9865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: WINDA ARISTIL
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 561-954-9865