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General NPI Number Information
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NPI Number | 1093168924
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Entity Type | Organization
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Legal Business Name | DIVINITY HOME HEALTHCARE, LLC
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Dates
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Enumeration Date | 07/15/2016
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Last Update Date | 03/23/2023
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Provider Practice Location Address
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Address Line | 1734 KINGSLEY AVE STE 3
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City | ORANGE PARK
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State | FL
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Zip | 32073-4418
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Country | US
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Telephone | 904-900-8073
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Fax |
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Provider Business Mailing Address
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Address Line | 3829 CARDINAL OAKS CIR
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City | ORANGE PARK
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State | FL
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Zip | 32065-4251
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Country | US
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Telephone | 561-543-1498
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Fax | 904-900-8113
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Authorized Official
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Title or Position | AMBR
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Name | GERT LOUIS
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Credential |
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Telephone | 561-543-1498
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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 |
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License Number State |
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