Healthcare Provider Details

I. General information

NPI: 1811201387
Provider Name (Legal Business Name): DIVINE HOME CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

446 SOUTH B
CROWDER OK
74430
US

IV. Provider business mailing address

446 SOUTH B STREET PO BOX 388
CROWDER OK
74430
US

V. Phone/Fax

Practice location:
  • Phone: 918-334-5580
  • Fax: 918-334-5581
Mailing address:
  • Phone: 918-334-5580
  • Fax: 918-334-5581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: LAMONA KAYE ESTES
Title or Position: CEO
Credential: RN CEO
Phone: 918-647-7829