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General NPI Number Information
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NPI Number | 1952740631
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Entity Type | Organization
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Legal Business Name | DIVINE HOME HEALTH AND AGENCY
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Dates
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Enumeration Date | 06/17/2013
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Last Update Date | 06/17/2013
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Provider Practice Location Address
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Address Line | 1004 WESTLAKE DR
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City | BOWIE
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State | MD
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Zip | 20721-1848
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Country | US
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Telephone | 301-538-2474
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Fax |
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Provider Business Mailing Address
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Address Line | 1004 WESTLAKE DR
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City | BOWIE
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State | MD
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Zip | 20721-1848
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | VIRGINIA ADEGBOYEGA
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Credential |
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Telephone | 301-538-2474
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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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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | RS3419
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License Number State | MD
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