Healthcare Provider Details

I. General information

NPI: 1306364492
Provider Name (Legal Business Name): DIVINE HOME CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 S HAMILTON RD
COLUMBUS OH
43213-3176
US

IV. Provider business mailing address

639 S HAMILTON RD
COLUMBUS OH
43213-3176
US

V. Phone/Fax

Practice location:
  • Phone: 614-432-6621
  • Fax:
Mailing address:
  • Phone: 614-432-6621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: GABRIEL MUNGAI
Title or Position: ADMINISTRATOR
Credential:
Phone: 614-432-6621