MEDICARE: DIVINE HOME HEALTH CARE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251J00000X	Nursing Care Agency
2	253Z00000X	In Home Supportive Care Agency
3	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1548689847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE HOME HEALTH CARE, LLC

Provider Business Mailing Address
First Line	:	4735 S SOUTHWIND DR
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85297-1973
Country	:	US
Telephone Number	:	480-812-3680
Fax Number	:

Provider Business Practice Location Address
First Line	:	633 E RAY RD STE 130
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-4206
Country	:	US
Telephone Number	:	480-812-3680
Fax Number	:

Authorized Official
Title or Position	:	DIR. OF NURSING
Name	:	GLORIA ADJEI
Credential	:	REGISTERED NURSE
Telephone Number	:	480-812-3680

Provider Enumeration Date	:	04/15/2014
Last Update Date	:	05/27/2025

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