Healthcare Provider Details

I. General information

NPI: 1255932737
Provider Name (Legal Business Name): DIVINE HEART SUPPORTIVE COMMUNITY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 INVESTORS PL STE 108
VIRGINIA BEACH VA
23452-1168
US

IV. Provider business mailing address

424 INVESTORS PL STE 108
VIRGINIA BEACH VA
23452-1168
US

V. Phone/Fax

Practice location:
  • Phone: 757-748-0424
  • Fax: 804-404-9532
Mailing address:
  • Phone: 757-748-0424
  • Fax: 804-404-9532

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 Code251S00000X
TaxonomyCommunity/Behavioral Health 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 Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MARGARET J HINES
Title or Position: OWNER/CEO
Credential:
Phone: 757-748-0424