Healthcare Provider Details

I. General information

NPI: 1073156527
Provider Name (Legal Business Name): DIVINE HOME HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21335 SIGNAL HILL PLZ STE 250
STERLING VA
20164-5567
US

IV. Provider business mailing address

40908 BEECHNUT RD
LEESBURG VA
20175-7031
US

V. Phone/Fax

Practice location:
  • Phone: 571-446-7997
  • 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

VIII. Authorized Official

Name: JASPREET SIDHU
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 571-446-7997