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General NPI Number Information
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NPI Number | 1912666462
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Entity Type | Organization
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Legal Business Name | DIVINE HUMANITY HOMECARE LLC.
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Dates
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Enumeration Date | 12/13/2021
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Last Update Date | 12/13/2021
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Provider Practice Location Address
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Address Line | 841 PRUDENTIAL DR FL 12
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8874
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Country | US
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Telephone | 904-333-3709
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Fax |
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Provider Business Mailing Address
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Address Line | 841 PRUDENTIAL DR FL 12
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8874
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Country | US
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Telephone | 904-333-3709
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MS. MONICA ANDREA PARKS
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Credential | RN
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Telephone | 904-333-3709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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