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General NPI Number Information
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NPI Number | 1245008739
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Entity Type | Organization
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Legal Business Name | DIVINELY PURPOSED CARE LLC
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Dates
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Enumeration Date | 12/14/2023
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Last Update Date | 12/14/2023
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Provider Practice Location Address
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Address Line | 255 S ORANGE AVE STE 104
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City | ORLANDO
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State | FL
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Zip | 32801-3411
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Country | US
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Telephone | 407-283-9855
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Fax |
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Provider Business Mailing Address
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Address Line | 831 OAKLEY SEAVER DR APT 410
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City | CLERMONT
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State | FL
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Zip | 34711-1990
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Country | US
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Telephone | 407-283-9855
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MR. DARRIS ANTON VICKERS II
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Credential |
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Telephone | 407-283-9855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training 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 | 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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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive 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 | 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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