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General NPI Number Information
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NPI Number | 1083349518
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Entity Type | Organization
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Legal Business Name | DEVINE PROVIDENCE HOME OF CARE
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Dates
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Enumeration Date | 07/19/2022
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Last Update Date | 07/19/2022
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Provider Practice Location Address
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Address Line | 3025 BLUE JAY LN
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City | MIDLOTHIAN
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State | TX
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Zip | 76065-8705
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Country | US
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Telephone | 682-375-6938
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Fax |
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Provider Business Mailing Address
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Address Line | 3025 BLUE JAY LN
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City | MIDLOTHIAN
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State | TX
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Zip | 76065-8705
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Country | US
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Telephone | 682-375-6938
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | CYNTHIA TUEDJO FEGAING
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Credential |
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Telephone | 682-375-3968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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