Healthcare Provider Details

I. General information

NPI: 1760004287
Provider Name (Legal Business Name): DIVINE MIRACLE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 E PIONEER PKWY
ARLINGTON TX
76010-5345
US

IV. Provider business mailing address

3201 E PIONEER PKWY
ARLINGTON TX
76010-5345
US

V. Phone/Fax

Practice location:
  • Phone: 682-347-4044
  • Fax:
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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: FOLAKE OBIOMA
Title or Position: PRESIDENT
Credential:
Phone: 682-252-2432