Healthcare Provider Details

I. General information

NPI: 1922522499
Provider Name (Legal Business Name): J&T DIVINE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 ROYELLOU LN
MOUNT DORA FL
32757-5510
US

IV. Provider business mailing address

440 ROYELLOU LN STE 205
MOUNT DORA FL
32757-5520
US

V. Phone/Fax

Practice location:
  • Phone: 352-729-2210
  • Fax: 352-729-2210
Mailing address:
  • Phone: 407-756-9492
  • Fax: 352-729-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number020680200
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TESICA BARNES
Title or Position: OWNER
Credential:
Phone: 407-756-9492