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General NPI Number Information
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NPI Number | 1285243345
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Entity Type | Organization
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Legal Business Name | DIVINE HEALTH CARE
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Dates
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Enumeration Date | 07/24/2020
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Last Update Date | 09/14/2020
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Provider Practice Location Address
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Address Line | 5851 LEGACY CIR STE 600
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City | PLANO
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State | TX
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Zip | 75024-5969
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Country | US
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Telephone | 501-353-8568
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Fax |
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Provider Business Mailing Address
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Address Line | 5851 LEGACY CIR STE 600
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City | PLANO
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State | TX
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Zip | 75024-5969
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Country | US
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Telephone | 501-353-8568
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LATOYAL ROBINSON
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Credential |
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Telephone | 501-353-5392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management 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 | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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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 | 305S00000X
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Taxonomy Name | Point of Service
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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 | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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Taxonomy #7
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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 #8
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 385HR2065X
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Taxonomy Name | Child Physical Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #11
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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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