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General NPI Number Information
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NPI Number | 1265262398
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Entity Type | Organization
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Legal Business Name | DIVINE SOURCE CARE, LLC
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Dates
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Enumeration Date | 08/05/2024
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 1547 W OAK ST
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City | ZIONSVILLE
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State | IN
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Zip | 46077-1840
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Country | US
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Telephone | 800-337-4491
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Fax |
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Provider Business Mailing Address
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Address Line | 1547 W OAK ST
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City | ZIONSVILLE
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State | IN
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Zip | 46077-1840
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Country | US
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Telephone | 800-337-4491
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE
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Name | SYDNEY GORDON
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Credential |
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Telephone | 317-499-2757
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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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Taxonomy #2
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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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 | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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