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General NPI Number Information
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NPI Number | 1083006647
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Entity Type | Organization
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Legal Business Name | DIVINE GRACE IN-HOME & PRIVATE HEALTHCARE SERVICE
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Dates
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Enumeration Date | 02/19/2015
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Last Update Date | 02/19/2015
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Provider Practice Location Address
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Address Line | 3535 S WILMINGTON ST STE 202 3535 SOUTH WILMINGTON STREET SUITE 202
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City | RALEIGH
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State | NC
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Zip | 27603-3512
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Country | US
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Telephone | 919-796-0734
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Fax |
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Provider Business Mailing Address
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Address Line | 3535 S WILMINGTON ST STE 202 SUITE 202
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City | RALEIGH
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State | NC
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Zip | 27603-3512
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Country | US
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Telephone | 919-796-0734
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID JR GRIFFIN
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Credential |
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Telephone | 919-796-0734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HC4729
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License Number State | NC
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