Healthcare Provider Details

I. General information

NPI: 1962328260
Provider Name (Legal Business Name): DIVINE LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 S FRONTAGE RD # 171
HASTINGS MN
55033-2483
US

IV. Provider business mailing address

1303 S FRONTAGE RD # 171
HASTINGS MN
55033-2483
US

V. Phone/Fax

Practice location:
  • Phone: 651-203-8772
  • Fax:
Mailing address:
  • Phone: 651-203-8772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CARISSA OZANGAR
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 651-203-8772