Healthcare Provider Details

I. General information

NPI: 1336383561
Provider Name (Legal Business Name): DIVINE HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2009
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 GRANVILLE ST STE A
GAHANNA OH
43230-3074
US

IV. Provider business mailing address

146 GRANVILLE ST STE A
GAHANNA OH
43230-3074
US

V. Phone/Fax

Practice location:
  • Phone: 614-269-7778
  • Fax: 614-269-7892
Mailing address:
  • Phone:
  • 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 Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MARY W MUNGAI
Title or Position: MANAGER
Credential: MBA, BSN/RN
Phone: 614-432-6620