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General NPI Number Information
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NPI Number | 1417457607
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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 | 02/14/2018
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Last Update Date | 02/14/2018
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Provider Practice Location Address
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Address Line | 797 TEAGUE TRL APT 13207
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City | LADY LAKE
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State | FL
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Zip | 32159-3152
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Country | US
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Telephone | 352-602-5541
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Fax |
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Provider Business Mailing Address
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Address Line | 797 TEAGUE TRL APT 13207
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City | LADY LAKE
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State | FL
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Zip | 32159-3152
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Country | US
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Telephone | 352-602-5541
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEONDRA BURCH
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Credential |
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Telephone | 352-602-5541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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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 | 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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