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General NPI Number Information
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NPI Number | 1962520635
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Entity Type | Organization
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Legal Business Name | DIVINE HOME CARE, LLC
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 05/06/2009
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Provider Practice Location Address
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Address Line | 751 S MAIN ST SUITE B
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City | RAEFORD
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State | NC
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Zip | 28376-3238
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Country | US
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Telephone | 910-904-2377
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Fax | 910-904-2477
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Provider Business Mailing Address
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Address Line | 751 S MAIN ST SUITE B
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City | RAEFORD
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State | NC
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Zip | 28376-3238
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Country | US
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Telephone | 910-904-2377
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Fax | 910-904-2477
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Authorized Official
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Title or Position | OWNER, SERVICE DIRECTOR
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Name | MRS. FLORINE L FLEMING
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Credential | RN
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Telephone | 910-904-2377
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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 | HC2882
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License Number State | NC
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