Healthcare Provider Details

I. General information

NPI: 1548494404
Provider Name (Legal Business Name): DIVINE HOME CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 BIRCH ST
RAEFORD NC
28376-3297
US

IV. Provider business mailing address

310 BIRCH ST
RAEFORD NC
28376-3297
US

V. Phone/Fax

Practice location:
  • Phone: 910-904-2377
  • Fax: 910-904-2477
Mailing address:
  • Phone: 910-904-2377
  • Fax: 910-904-2477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberHC2882
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberHC2882
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC2882
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License NumberHC2882
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHC2882
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberHC2882
License Number StateNC

VIII. Authorized Official

Name: MS. FLORINE L FLEMING
Title or Position: PRESIDENT
Credential: RN LIC #. 146850
Phone: 910-904-2377