Healthcare Provider Details

I. General information

NPI: 1902356918
Provider Name (Legal Business Name): DHC DIVINE HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 N 10TH ST STE C
MCALLEN TX
78504-3020
US

IV. Provider business mailing address

4309 N 10TH ST STE C
MCALLEN TX
78504-3020
US

V. Phone/Fax

Practice location:
  • Phone: 956-563-7509
  • Fax: 956-687-7509
Mailing address:
  • Phone: 956-563-7509
  • Fax: 956-687-7509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number013812
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LISA ANN BLUM
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 956-563-7509