MEDICARE: DIVINE TOUCH HEALTHCARE 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1447554688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE TOUCH HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	659 EAGLE ROCK AVE
Second Line	:	SUITE 20
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-2138
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	659 EAGLE ROCK AVE
Second Line	:	SUITE 20
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-2138
Country	:	US
Telephone Number	:	973-517-4191
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	VINETTE HIBBERT
Credential	:
Telephone Number	:	973-517-4191

Provider Enumeration Date	:	01/03/2011
Last Update Date	:	01/03/2011

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