Healthcare Provider Details

I. General information

NPI: 1992528350
Provider Name (Legal Business Name): DIVINE HANDS HOME HEALTH AGENCY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 SHINGLE CREEK PKWY STE 615A
BROOKLYN CENTER MN
55430-2493
US

IV. Provider business mailing address

5701 SHINGLE CREEK PKWY STE 615A
BROOKLYN CENTER MN
55430-2493
US

V. Phone/Fax

Practice location:
  • Phone: 952-452-1031
  • Fax:
Mailing address:
  • Phone: 952-452-1031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. JOSEPHINE S LANSANA-GBONGAY
Title or Position: OWNER/DIRECTOR
Credential: REGISTER NURSE
Phone: 952-657-9629