Healthcare Provider Details

I. General information

NPI: 1013446475
Provider Name (Legal Business Name): DIVINE CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21212 SE 62ND AVE
HAWTHORNE FL
32640
US

IV. Provider business mailing address

21212 SE 62ND AVE
HAWTHORNE FL
32640-3527
US

V. Phone/Fax

Practice location:
  • Phone: 352-870-9651
  • Fax:
Mailing address:
  • Phone: 352-870-9651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number49023
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number232986
License Number StateFL

VIII. Authorized Official

Name: NATASHA SHANTEL WILLIAMS
Title or Position: CEO
Credential:
Phone: 352-870-9651