Healthcare Provider Details

I. General information

NPI: 1316431547
Provider Name (Legal Business Name): DIVICARE HOME HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 04/24/2021
Certification Date: 04/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8005 N MACARTHUR BLVD APT 2017
IRVING TX
75063-7648
US

IV. Provider business mailing address

8005 N MACARTHUR BLVD APT 2017
IRVING TX
75063-7648
US

V. Phone/Fax

Practice location:
  • Phone: 469-583-9678
  • Fax: 214-889-7700
Mailing address:
  • Phone: 469-583-9678
  • Fax: 214-889-7700

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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name: EDITH CHINYERE MONTGOMERY
Title or Position: OWNER
Credential: RN
Phone: 469-583-9678