=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952238503
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | D DIVINE SERENITY LIVING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2026
-----------------------------------------------------
Last Update Date | 05/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3518 ASPIRE CIR APT 5409
-----------------------------------------------------
City | CAPE CORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33914-5595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-990-1464
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3518 ASPIRE CIR APT 5409
-----------------------------------------------------
City | CAPE CORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33914-5595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-990-1464
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LIDIA D POLO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 239-990-1464
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 376J00000X
-----------------------------------------------------
Taxonomy Name | Homemaker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------