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General NPI Number Information
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NPI Number | 1679258719
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Entity Type | Organization
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Legal Business Name | DIVINE HEALTH AND WELLNESS HOME CARE LLC
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Dates
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Enumeration Date | 06/16/2023
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Last Update Date | 06/16/2023
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Provider Practice Location Address
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Address Line | 165 MAHALEY AVE STE 1060
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City | SALISBURY
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State | NC
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Zip | 28144-2448
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Country | US
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Telephone | 704-970-7998
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Fax | 980-330-5020
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Provider Business Mailing Address
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Address Line | 165 MAHALEY AVE STE 1060
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City | SALISBURY
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State | NC
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Zip | 28144-2448
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Country | US
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Telephone | 704-970-7998
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Fax | 980-330-5020
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Authorized Official
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Title or Position | OWNER
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Name | TAMIKA BURNS
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Credential | BSN, RN
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Telephone | 704-970-7998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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