Healthcare Provider Details

I. General information

NPI: 1689028490
Provider Name (Legal Business Name): DIVINE HOME CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 04/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 THIMBLE SHOALS BLVD 503
NEWPORT NEWS VA
23606-3562
US

IV. Provider business mailing address

739 THIMBLE SHOALS BLVD 503
NEWPORT NEWS VA
23606-3562
US

V. Phone/Fax

Practice location:
  • Phone: 757-768-6021
  • Fax:
Mailing address:
  • Phone: 757-768-6021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MRS. DALITHEA SMALLS
Title or Position: CEO/ADMINISTRATOR
Credential:
Phone: 757-768-6021