Healthcare Provider Details

I. General information

NPI: 1992030183
Provider Name (Legal Business Name): DIVINE HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 10/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 CHARTIERS AVE
MC KEES ROCKS PA
15136-3736
US

IV. Provider business mailing address

1110 CHARTIERS AVE
MC KEES ROCKS PA
15136-3736
US

V. Phone/Fax

Practice location:
  • Phone: 412-875-6018
  • Fax: 412-875-6044
Mailing address:
  • Phone: 412-875-6018
  • Fax: 412-875-6044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number03790501
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TASHA MARIE MCKENZIE
Title or Position: OWNER
Credential:
Phone: 412-875-6018