Healthcare Provider Details

I. General information

NPI: 1427598564
Provider Name (Legal Business Name): D'VINE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2017
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 W WASHINGTON ST STE 602
SUFFOLK VA
23434-5246
US

IV. Provider business mailing address

112 W WASHINGTON ST STE 602
SUFFOLK VA
23434-5246
US

V. Phone/Fax

Practice location:
  • Phone: 757-539-0002
  • Fax: 757-529-0012
Mailing address:
  • Phone: 757-539-0002
  • Fax: 757-529-0012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANGELE HILLARD
Title or Position: ADMINISTRATOR
Credential:
Phone: 757-237-2123