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General NPI Number Information
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NPI Number | 1841215712
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Entity Type | Organization
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Legal Business Name | DIVINE HOME CARE INC
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 03/22/2019
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Provider Practice Location Address
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Address Line | 322 2ND ST SW
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City | WILLMAR
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State | MN
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Zip | 56201
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Country | US
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Telephone | 320-231-9757
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Fax | 320-231-9795
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Provider Business Mailing Address
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Address Line | 322 2ND ST SW
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City | WILLMAR
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State | MN
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Zip | 56201
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Country | US
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Telephone | 320-231-9757
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Fax | 320-231-9795
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | PAM BREDE
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Credential | NURSE
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Telephone | 320-231-9757
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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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