MEDICARE: DIVINE FAITH, PRIMARY HOME CARE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	253Z00000X	In Home Supportive Care Agency
3	385H00000X	Respite Care
4	376J00000X	Homemaker
5	251C00000X	Developmentally Disabled Services Day Training Agency
6	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1275148405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE FAITH, PRIMARY HOME CARE, LLC

Provider Business Mailing Address
First Line	:	30602 SAINT FRANCIS AVE
Second Line	:
City	:	LOS FRESNOS
State	:	TX
Zip	:	78566-8331
Country	:	US
Telephone Number	:	956-484-2233
Fax Number	:	844-828-4998

Provider Business Practice Location Address
First Line	:	33989 FM 1421
Second Line	:
City	:	SAN BENITO
State	:	TX
Zip	:	78586-8328
Country	:	US
Telephone Number	:	956-484-2233
Fax Number	:	844-828-4998

Authorized Official
Title or Position	:	OWNER
Name	:	JOSIE A RODRIGUEZ
Credential	:
Telephone Number	:	956-484-2233

Provider Enumeration Date	:	09/14/2020
Last Update Date	:	02/20/2026

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