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General NPI Number Information
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NPI Number | 1588487789
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Entity Type | Organization
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Legal Business Name | DIVINE HOME CARE AGENCY LLC
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Dates
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Enumeration Date | 11/05/2024
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 4244 CUMBERLAND RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28306-2697
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Country | US
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Telephone | 910-491-1002
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Fax |
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Provider Business Mailing Address
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Address Line | 1610 SHIVELY CT
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-4034
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Country | US
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Telephone | 910-670-5458
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Fax |
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Authorized Official
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Title or Position | CHEIF EXECUTIVE OFFICER
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Name | TAMIKO L MATTHEWS
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Credential |
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Telephone | 910-670-5458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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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