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General NPI Number Information
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NPI Number | 1356084891
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Entity Type | Organization
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Legal Business Name | GEORGIA'S DIVINE HOME CARE LLC
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Dates
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Enumeration Date | 04/13/2022
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Last Update Date | 04/13/2022
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Provider Practice Location Address
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Address Line | 2883 BASKIN ST
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City | MEMPHIS
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State | TN
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Zip | 38127-7705
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Country | US
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Telephone | 901-495-3857
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Fax |
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Provider Business Mailing Address
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Address Line | 2883 BASKIN ST
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City | MEMPHIS
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State | TN
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Zip | 38127-7705
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Country | US
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Telephone | 901-495-3857
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MATILDA SMITH
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Credential |
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Telephone | 901-495-3857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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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 | 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 #4
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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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