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General NPI Number Information
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NPI Number | 1538678651
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Entity Type | Organization
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Legal Business Name | DIVINE HERITAGE HEALTH HOME CARE AGENCY LLC
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Dates
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Enumeration Date | 09/20/2017
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Last Update Date | 12/01/2020
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Provider Practice Location Address
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Address Line | 431 W WINTERGREEN RD
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City | DESOTO
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State | TX
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Zip | 75115-2394
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Country | US
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Telephone | 979-803-0032
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Fax |
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Provider Business Mailing Address
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Address Line | 5757 N LINCOLN AVE STE 23
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City | CHICAGO
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State | IL
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Zip | 60659-4729
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Country | US
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Telephone | 872-208-5385
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Fax | 872-208-5354
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Authorized Official
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Title or Position | HEALTH CARE ADMINISTRATOR
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Name | MARY LOUISE GAINES
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Credential |
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Telephone | 612-440-2462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State | IN
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Taxonomy #5
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Taxonomy Code | 282J00000X
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Taxonomy Name | Religious Nonmedical Health Care Institution
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License Number |
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License Number State | TX
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