Healthcare Provider Details

I. General information

NPI: 1932813250
Provider Name (Legal Business Name): DIVINE HEALTH CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2023
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 MARY ST
ARLINGTON TX
76010-2716
US

IV. Provider business mailing address

1006 MARY ST
ARLINGTON TX
76010-2716
US

V. Phone/Fax

Practice location:
  • Phone: 817-896-8222
  • Fax:
Mailing address:
  • Phone: 817-896-8222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SARAH MENSAH-TAYLOR
Title or Position: MANAGER
Credential:
Phone: 817-896-8222