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General NPI Number Information
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NPI Number | 1831107093
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Entity Type | Organization
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Legal Business Name | DIVINE HOME HEALTH, INC.
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 04/04/2025
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Provider Practice Location Address
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Address Line | 14241 FIRESTONE BLVD STE 235
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City | LA MIRADA
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State | CA
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Zip | 90638-5521
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Country | US
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Telephone | 562-407-0288
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Fax | 562-407-0290
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Provider Business Mailing Address
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Address Line | 14241 FIRESTONE BLVD STE 235
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City | LA MIRADA
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State | CA
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Zip | 90638-5521
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Country | US
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Telephone | 562-407-0288
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Fax | 562-407-0290
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. HAN S. KIM
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Credential |
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Telephone | 562-407-0288
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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 | 980001120
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License Number State | CA
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