Healthcare Provider Details

I. General information

NPI: 1952602849
Provider Name (Legal Business Name): DHC DIVINE HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2010
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 NORTH 10TH STREET STE. C
MCALLEN TX
78504
US

IV. Provider business mailing address

4309 NORTH 10TH STREET STE. C
MCALLEN TX
78504
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 Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number013812
License Number StateTX

VIII. Authorized Official

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