Healthcare Provider Details

I. General information

NPI: 1265371652
Provider Name (Legal Business Name): DIVINE CARE COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13176 JEFFERSON AVE STE D
NEWPORT NEWS VA
23608-1322
US

IV. Provider business mailing address

13176 JEFFERSON AVE STE D
NEWPORT NEWS VA
23608-1322
US

V. Phone/Fax

Practice location:
  • Phone: 757-773-6304
  • Fax:
Mailing address:
  • Phone: 984-335-5005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. YASHICA T RUSSELL
Title or Position: OWNER
Credential: RUSSELL
Phone: 984-335-5005