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General NPI Number Information
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NPI Number | 1851972145
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Entity Type | Organization
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Legal Business Name | DIVINE HEALTHCARE SERVICES, LLC
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Dates
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Enumeration Date | 04/18/2021
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Last Update Date | 04/18/2021
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Provider Practice Location Address
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Address Line | 6812 IVY LOG DR
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City | AUSTELL
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State | GA
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Zip | 30168-5912
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Country | US
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Telephone | 877-516-4818
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Fax |
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Provider Business Mailing Address
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Address Line | 6812 IVY LOG DR
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City | AUSTELL
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State | GA
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Zip | 30168-5912
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Country | US
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Telephone | 877-516-4818
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIMBERLY CARR
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Credential |
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Telephone | 877-516-4818
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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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