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General NPI Number Information
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NPI Number | 1407366685
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Entity Type | Organization
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Legal Business Name | DIVINE HOME HEALTH CARE INC
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Dates
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Enumeration Date | 10/02/2017
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Last Update Date | 10/02/2017
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Provider Practice Location Address
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Address Line | 4555 NE 66TH AVE
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City | VANCOUVER
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State | WA
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Zip | 98661-3181
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Country | US
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Telephone | 360-314-2561
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Fax | 360-314-2943
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Provider Business Mailing Address
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Address Line | 1118 20TH AVE
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City | LONGVIEW
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State | WA
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Zip | 98632-2222
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Country | US
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Telephone | 360-747-7716
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Fax |
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | MARLENE DEBRA JONES
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Credential | RN
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Telephone | 360-747-7716
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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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