MEDICARE: DIVINELY PURPOSED CARE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	251S00000X	Community/Behavioral Health Agency
3	253Z00000X	In Home Supportive Care Agency
4	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1245008739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINELY PURPOSED CARE LLC

Provider Business Mailing Address
First Line	:	831 OAKLEY SEAVER DR APT 410
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-1990
Country	:	US
Telephone Number	:	407-283-9855
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 S ORANGE AVE STE 104
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32801-3411
Country	:	US
Telephone Number	:	407-283-9855
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MR. DARRIS ANTON VICKERS II
Credential	:
Telephone Number	:	407-283-9855

Provider Enumeration Date	:	12/14/2023
Last Update Date	:	12/14/2023

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Directions to “DIVINELY PURPOSED CARE LLC ” Practice Location

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