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General NPI Number Information
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NPI Number | 1689374878
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Entity Type | Organization
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Legal Business Name | DIVINE INTERVENTION HOME CARE AGENCY LLC
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Dates
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Enumeration Date | 03/06/2023
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Last Update Date | 06/23/2023
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Provider Practice Location Address
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Address Line | 3035 DIRECTORS ROW STE 320
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City | MEMPHIS
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State | TN
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Zip | 38131-0420
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Country | US
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Telephone | 901-598-8882
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Fax |
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Provider Business Mailing Address
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Address Line | 3035 DIRECTORS ROW STE 320
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City | MEMPHIS
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State | TN
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Zip | 38131-0420
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Country | US
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Telephone | 901-598-8882
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. KIM R BYRD
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Credential |
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Telephone | 901-598-8882
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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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