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General NPI Number Information
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NPI Number | 1760220156
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Entity Type | Organization
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Legal Business Name | DIVINE WELLNESS HOME HEALTH LLC.
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Dates
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Enumeration Date | 07/18/2024
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 1501 LAKE GROVE DR
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City | LITTLE ELM
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State | TX
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Zip | 75068-8655
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Country | US
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Telephone | 945-289-5483
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 LAKE GROVE DR
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City | LITTLE ELM
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State | TX
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Zip | 75068-8655
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Country | US
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Telephone | 945-289-5483
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Fax |
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Authorized Official
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Title or Position | OWNER/ ADMINISTRATOR
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Name | REMONICA LASHA WALLER
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Credential |
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Telephone | 945-289-5483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management 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 | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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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 | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 385HR2065X
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Taxonomy Name | Child Physical Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #6
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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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