Healthcare Provider Details

I. General information

NPI: 1912666462
Provider Name (Legal Business Name): DIVINE HUMANITY HOMECARE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 PRUDENTIAL DR FL 12
JACKSONVILLE FL
32207-8874
US

IV. Provider business mailing address

841 PRUDENTIAL DR FL 12
JACKSONVILLE FL
32207-8874
US

V. Phone/Fax

Practice location:
  • Phone: 904-333-3709
  • Fax:
Mailing address:
  • Phone: 904-333-3709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. MONICA ANDREA PARKS
Title or Position: OWNER/CEO
Credential: RN
Phone: 904-333-3709