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General NPI Number Information
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NPI Number | 1730583154
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Entity Type | Organization
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Legal Business Name | DIVINE HEALTH HOME CARE AGENCY, INC.
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Dates
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Enumeration Date | 10/14/2014
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Last Update Date | 10/14/2014
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Provider Practice Location Address
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Address Line | 9707 TRAVER ST
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City | MITCHELLVILLE
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State | MD
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Zip | 20721-1867
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Country | US
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Telephone | 202-400-0849
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Fax | 866-405-4896
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Provider Business Mailing Address
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Address Line | 9707 TRAVER ST
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City | MITCHELLVILLE
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State | MD
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Zip | 20721-1867
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Country | US
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Telephone | 202-400-0849
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Fax | 866-405-4896
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARY ANDREWS
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Credential |
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Telephone | 202-400-0849
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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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