Healthcare Provider Details

I. General information

NPI: 1134994890
Provider Name (Legal Business Name): ANNIE'S DIVINE TOUCH HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2023
Last Update Date: 11/22/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2807 N PARHAM RD RM 370
HENRICO VA
23294-4410
US

IV. Provider business mailing address

6405 WOODED GLEN CT APT 201
CHESTER VA
23831-7790
US

V. Phone/Fax

Practice location:
  • Phone: 804-454-5610
  • Fax:
Mailing address:
  • Phone: 804-454-5610
  • 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 Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: BREANNA TOMES
Title or Position: CEO
Credential:
Phone: 804-454-5610