=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366333452
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIVINE FAVOR LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2025
-----------------------------------------------------
Last Update Date | 07/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 825 S ILLINOIS ST
-----------------------------------------------------
City | SOUTH BEND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46619-2914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-400-7734
-----------------------------------------------------
Fax | 317-707-9505
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5759 CHIPMUNK RUN APT A
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46254-1474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-400-7734
-----------------------------------------------------
Fax | 317-707-9505
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | SONYA DENISIE BROWN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 317-400-7734
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------