Healthcare Provider Details

I. General information

NPI: 1942120084
Provider Name (Legal Business Name): S & R DIVINE HOMECARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5430 EXECUTIVE PL STE 2B
JACKSON MS
39206-4134
US

IV. Provider business mailing address

5430 EXECUTIVE PL STE 2B
JACKSON MS
39206-4134
US

V. Phone/Fax

Practice location:
  • Phone: 601-900-7218
  • Fax: 601-900-7218
Mailing address:
  • Phone: 601-900-7218
  • Fax: 601-900-7218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. LATONYA TORNS
Title or Position: OWNER
Credential: TYPE 2 NPI
Phone: 601-900-7218