=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437977725
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIVINE TOUCH HOME HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2024
-----------------------------------------------------
Last Update Date | 09/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13678 SWEET WOODRUFF LN
-----------------------------------------------------
City | CENTREVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20120-2604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-294-0971
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13678 SWEET WOODRUFF LN
-----------------------------------------------------
City | CENTREVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20120-2604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-294-0971
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSING DIRECTOR
-----------------------------------------------------
Name | MICHELLE SHALITA
-----------------------------------------------------
Credential | RN, BSN, MSN
-----------------------------------------------------
Telephone | 202-294-0971
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------