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General NPI Number Information
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NPI Number | 1730882333
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Entity Type | Organization
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Legal Business Name | DIVINE CARE LLC
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Dates
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Enumeration Date | 03/23/2023
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Last Update Date | 03/23/2023
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Provider Practice Location Address
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Address Line | 325 RIVERSIDE PKWY SW APT 3J
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City | AUSTELL
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State | GA
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Zip | 30168-7350
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Country | US
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Telephone | 404-399-1294
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Fax |
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Provider Business Mailing Address
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Address Line | 325 RIVERSIDE PKWY SW APT 3J
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City | AUSTELL
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State | GA
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Zip | 30168-7350
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Country | US
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Telephone | 404-399-1294
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NKECHI M EKWEALOR
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Credential |
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Telephone | 443-399-1294
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #3
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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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