MEDICARE: DIVINE COMFORT HOME HEALTH 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2672250715	OTHER		BUSINESS PHONE

General Provider Information

NPI Number	:	1558972968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE COMFORT HOME HEALTH LLC

Provider Business Mailing Address
First Line	:	6411 N 6TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19126-3806
Country	:	US
Telephone Number	:	267-408-1209
Fax Number	:

Provider Business Practice Location Address
First Line	:	6411 N 6TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19126-3806
Country	:	US
Telephone Number	:	267-408-1209
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. HAROLD ALLEN
Credential	:
Telephone Number	:	267-408-1209

Provider Enumeration Date	:	08/11/2020
Last Update Date	:	08/11/2020

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