MEDICARE: DIVINE LOVE HOMECARE 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	276662100	MN

General Provider Information

NPI Number	:	1588838122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE LOVE HOMECARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	4600 OXBOROUGH GDNS
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-3910
Country	:	US
Telephone Number	:	612-251-6610
Fax Number	:

Provider Business Practice Location Address
First Line	:	4600 OXBOROUGH GDNS
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-3910
Country	:	US
Telephone Number	:	612-251-6610
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. UCHE CHINYERE OBIDIEGWU
Credential	:
Telephone Number	:	612-251-6610

Provider Enumeration Date	:	04/15/2008
Last Update Date	:	04/15/2008

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