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General NPI Number Information
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NPI Number | 1356676746
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Entity Type | Organization
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Legal Business Name | DVINE CARE
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Dates
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Enumeration Date | 10/02/2009
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Last Update Date | 01/30/2012
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Provider Practice Location Address
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Address Line | 2102 TRADEWIND DR SUITE 172
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City | MESQUITE
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State | TX
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Zip | 75150-3309
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Country | US
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Telephone | 601-810-5788
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Fax |
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Provider Business Mailing Address
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Address Line | 1017 HANEY RD. SUITE.C
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City | SUMMIT
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State | MS
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Zip | 39666
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Country | US
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Telephone | 601-810-5788
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MICHAEL EDWARDS
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Credential |
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Telephone | 601-810-5788
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | MS
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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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