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General NPI Number Information
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NPI Number | 1265371652
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Entity Type | Organization
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Legal Business Name | DIVINE CARE COLLECTIVE LLC
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Dates
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Enumeration Date | 03/28/2026
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Last Update Date | 03/28/2026
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Provider Practice Location Address
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Address Line | 13176 JEFFERSON AVE STE D
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City | NEWPORT NEWS
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State | VA
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Zip | 23608-1322
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Country | US
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Telephone | 757-773-6304
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Fax |
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Provider Business Mailing Address
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Address Line | 108 EMMA ROSE CT
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-5787
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Country | US
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Telephone | 984-335-5005
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. YASHICA T RUSSELL
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Credential | RUSSELL
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Telephone | 984-335-5005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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