Healthcare Provider Details

I. General information

NPI: 1851562052
Provider Name (Legal Business Name): DIVINE PURPOSE HOMECARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 06/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 SHERBROOKE CT
HARVEY LA
70058-7454
US

IV. Provider business mailing address

15 5TH ST
GRETNA LA
70053-4744
US

V. Phone/Fax

Practice location:
  • Phone: 504-361-8242
  • Fax: 504-361-3700
Mailing address:
  • Phone: 504-361-8242
  • Fax: 504-361-3700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMANDA H WILKERSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 504-361-8242