Healthcare Provider Details

I. General information

NPI: 1356285712
Provider Name (Legal Business Name): DIVINE CARE NURSING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 N 42ND ST STE 208
MILWAUKEE WI
53209-3560
US

IV. Provider business mailing address

6100 N 42ND ST STE 208
MILWAUKEE WI
53209-3560
US

V. Phone/Fax

Practice location:
  • Phone: 414-361-2363
  • Fax: 414-361-2447
Mailing address:
  • Phone: 414-795-9761
  • Fax: 414-361-2447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome 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 Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: DESTINY C GREEN
Title or Position: OWNER
Credential: RN
Phone: 414-795-9761