Healthcare Provider Details

I. General information

NPI: 1801923156
Provider Name (Legal Business Name): DIVINITY HEALTHCARE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6193 MAIN ST
BAILEY NC
27807-0157
US

IV. Provider business mailing address

6193 MAIN ST.
BAILEY NC
27807
US

V. Phone/Fax

Practice location:
  • Phone: 252-235-0404
  • Fax:
Mailing address:
  • Phone: 252-235-0404
  • Fax: 252-235-5813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC3070
License Number StateNC

VIII. Authorized Official

Name: SHIRLEREE SUTTON WINSTEAD
Title or Position: CEO
Credential:
Phone: 252-235-0404