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General NPI Number Information
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NPI Number | 1306717061
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Entity Type | Organization
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Legal Business Name | DIVINELY CHOSEN SERVICES
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Dates
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Enumeration Date | 09/16/2025
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 3261 US 441 SUITE B2
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City | FRUITLAND PARK
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State | FL
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Zip | 34731
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Country | US
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Telephone | 689-290-6060
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Fax |
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Provider Business Mailing Address
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Address Line | 5252 HARTWOOD LOOP
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City | WILDWOOD
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State | FL
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Zip | 34785-7926
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Country | US
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Telephone | 689-290-6060
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | MR. KEONDRA JOHNSON
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Credential | PN5256124
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Telephone | 689-290-6060
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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 | 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 #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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