MEDICARE: DIVINITY SENIOR CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1043786866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINITY SENIOR CARE

Provider Business Mailing Address
First Line	:	437 FARNSWORTH RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29301-1625
Country	:	US
Telephone Number	:	864-529-6830
Fax Number	:

Provider Business Practice Location Address
First Line	:	437 FARNSWORTH RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29301-1625
Country	:	US
Telephone Number	:	864-529-6830
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHAUNTY MICHELLE SWINDLER
Credential	:
Telephone Number	:	864-529-6830

Provider Enumeration Date	:	10/18/2018
Last Update Date	:	06/06/2019

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Directions to “DIVINITY SENIOR CARE ” Practice Location

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