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General NPI Number Information
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NPI Number | 1154818706
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Entity Type | Organization
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Legal Business Name | FIRST DIVINE HOME HEALTHCARE AGENCY INC.
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Dates
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Enumeration Date | 04/19/2018
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Last Update Date | 04/19/2018
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Provider Practice Location Address
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Address Line | 7901 CAMERON RD STE 302
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City | AUSTIN
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State | TX
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Zip | 78754-3831
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Country | US
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Telephone | 512-775-6392
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Fax | 512-990-8387
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Provider Business Mailing Address
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Address Line | 2612 BYFIELD DR
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City | CEDAR PARK
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State | TX
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Zip | 78613-7614
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Country | US
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Telephone | 512-870-7395
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Fax | 512-456-7450
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Authorized Official
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Title or Position | ADMINISTRATOR/OWNER
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Name | FLORENCE TUBONEMI
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Credential | RN
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Telephone | 512-870-7395
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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 | 010400
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License Number State | TX
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