Healthcare Provider Details

I. General information

NPI: 1831820265
Provider Name (Legal Business Name): DIVINE ROSE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3114 BOUDINOT AVE UNIT 1
CINCINNATI OH
45211-7006
US

IV. Provider business mailing address

3114 BOUDINOT AVE UNIT 1
CINCINNATI OH
45211-7006
US

V. Phone/Fax

Practice location:
  • Phone: 513-580-6662
  • Fax:
Mailing address:
  • Phone: 513-580-6662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL ADDAI
Title or Position: OWNER/PRESIDENT/ADMINISTRATOR
Credential:
Phone: 513-580-6662