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General NPI Number Information
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NPI Number | 1700066073
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Entity Type | Organization
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Legal Business Name | DIVINE HANDS OF CARE, INC
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Dates
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Enumeration Date | 11/05/2007
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Last Update Date | 03/17/2017
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Provider Practice Location Address
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Address Line | 4140 WORLINGTON TER
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City | FORT PIERCE
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State | FL
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Zip | 34947-1335
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Country | US
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Telephone | 772-528-6628
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Fax | 772-466-4988
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Provider Business Mailing Address
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Address Line | 4140 WORLINGTON TER
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City | FORT PIERCE
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State | FL
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Zip | 34947-1335
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Country | US
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Telephone | 772-528-6628
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Fax | 772-466-4988
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Authorized Official
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Title or Position | CEO
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Name | MR. DAN EDWARD DARRISAW II
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Credential |
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Telephone | 772-528-6628
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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 | 688140896
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License Number State | FL
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