MEDICARE: DEVINE SUPPORT SERVICES LLC

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	:	1417809476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEVINE SUPPORT SERVICES LLC

Provider Business Mailing Address
First Line	:	2310 N HENDERSON AVE STE B
Second Line	:	#1573
City	:	DALLAS
State	:	TX
Zip	:	75206
Country	:	US
Telephone Number	:	813-446-0375
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 CADIZ AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75215
Country	:	US
Telephone Number	:	813-446-0375
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. NERRICA NICOLE DEVINE
Credential	:
Telephone Number	:	813-446-0375

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	02/12/2026

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Directions to “DEVINE SUPPORT SERVICES LLC ” Practice Location

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