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General NPI Number Information
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NPI Number | 1730901943
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Entity Type | Organization
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Legal Business Name | DIVINE SUPPORT SERVICES, LLC.
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Dates
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Enumeration Date | 10/29/2024
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 51 PLAZA DR # D-2
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City | JACKSONVILLE
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State | NC
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Zip | 28540-5068
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Country | US
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Telephone | 800-622-1325
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Fax |
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Provider Business Mailing Address
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Address Line | 5116 WESTERN BLVD APT 523
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City | JACKSONVILLE
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State | NC
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Zip | 28546-0014
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Country | US
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Telephone | 800-622-1325
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. RACHEL JORDAN
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Credential | DHA
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Telephone | 800-622-1325
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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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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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