Healthcare Provider Details

I. General information

NPI: 1992133664
Provider Name (Legal Business Name): DIVINE INTERVENTIONS HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2013
Last Update Date: 10/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 PATRICK DR
SNOW HILL NC
28580-9515
US

IV. Provider business mailing address

1108A KINGOLD BLVD
SNOW HILL NC
28580-1619
US

V. Phone/Fax

Practice location:
  • Phone: 252-747-6570
  • Fax:
Mailing address:
  • Phone: 252-747-6570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNC

VIII. Authorized Official

Name: LAKECIA DUPREE
Title or Position: PRESIDENT
Credential:
Phone: 252-747-6570