=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861378077
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | D'VINE HOME CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2025
-----------------------------------------------------
Last Update Date | 08/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1700 S 1ST AVE STE 307
-----------------------------------------------------
City | YUMA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85364-5749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-509-5964
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1700 S 1ST AVE STE 307
-----------------------------------------------------
City | YUMA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85364-5749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-509-5964
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR/OWNER
-----------------------------------------------------
Name | JHOANA CAMACHO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 442-456-9455
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------