Healthcare Provider Details

I. General information

NPI: 1225489487
Provider Name (Legal Business Name): DIVINITY ADVANTAGE PERSONAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 06/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2387 WORRELL RD
UTICA MS
39175-9302
US

IV. Provider business mailing address

2387 WORRELL RD
UTICA MS
39175-9302
US

V. Phone/Fax

Practice location:
  • Phone: 601-885-2360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. CAROLYN K DIVINITY
Title or Position: CO-OWNER/MANAGER
Credential: MSW
Phone: 601-885-2360