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General NPI Number Information
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NPI Number | 1609447143
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Entity Type | Organization
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Legal Business Name | DIVINE KEEPERS HOMECARE SERVICES LLC
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Dates
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Enumeration Date | 07/06/2021
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Last Update Date | 10/11/2022
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Provider Practice Location Address
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Address Line | 103 TAPPAN ZEE DR
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City | POOLER
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State | GA
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Zip | 31322-9440
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Country | US
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Telephone | 843-333-0213
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Fax |
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Provider Business Mailing Address
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Address Line | 103 TAPPAN ZEE DR
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City | POOLER
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State | GA
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Zip | 31322-9440
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Country | US
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Telephone | 843-333-0213
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TURKESSA MOODY
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Credential |
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Telephone | 843-333-0213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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