Healthcare Provider Details

I. General information

NPI: 1073104980
Provider Name (Legal Business Name): A & A DEVINE HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3309 HERRON DR
MELISSA TX
75454-0318
US

IV. Provider business mailing address

3309 HERRON DR
MELISSA TX
75454-0318
US

V. Phone/Fax

Practice location:
  • Phone: 405-314-6181
  • 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

VIII. Authorized Official

Name: ESTHER TABENYANG
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 405-314-6181