Healthcare Provider Details

I. General information

NPI: 1477148906
Provider Name (Legal Business Name): ACL. DIVINE QUALITY HOME HEALTH AGENCY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2021
Last Update Date: 03/06/2021
Certification Date: 03/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11052 CAPTAIN DR
SPRING HILL FL
34608-5008
US

IV. Provider business mailing address

11052 CAPTAIN DR
SPRING HILL FL
34608-5008
US

V. Phone/Fax

Practice location:
  • Phone: 813-416-4685
  • Fax: 813-416-4685
Mailing address:
  • Phone: 813-416-4685
  • Fax: 813-416-4685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MARIE ROBINSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 813-416-4685