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General NPI Number Information
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NPI Number | 1265883995
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Entity Type | Organization
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Legal Business Name | DIVINE HOME HEALTH CARE LLC
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Dates
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Enumeration Date | 06/23/2016
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Last Update Date | 06/23/2016
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Provider Practice Location Address
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Address Line | 2206 EXECUTIVE DR SUITE A
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City | HAMPTON
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State | VA
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Zip | 23666-2583
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Country | US
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Telephone | 757-224-7124
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Fax |
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Provider Business Mailing Address
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Address Line | 2206 EXECUTIVE DR SUITE A
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City | HAMPTON
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State | VA
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Zip | 23666-2583
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Country | US
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Telephone | 757-224-7124
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAIMANDA THOMPSON
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Credential |
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Telephone | 757-604-8863
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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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