Healthcare Provider Details

I. General information

NPI: 1912520529
Provider Name (Legal Business Name): DIVINE HUMANITY HOMECARE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 PRUDENTIAL DR STE 1214
JACKSONVILLE FL
32207-8329
US

IV. Provider business mailing address

841 PRUDENTIAL DR STE 1214
JACKSONVILLE FL
32207-8329
US

V. Phone/Fax

Practice location:
  • Phone: 904-371-6586
  • Fax:
Mailing address:
  • Phone: 904-371-6586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: MS. MONICA ANDREA PARKS
Title or Position: CEO/OWNER
Credential:
Phone: 904-413-6381