MEDICARE: DIVINE TORCH HEALTH SERVICES, INC.

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	3747P1801X	Personal Care Attendant
2	251E00000X	Home Health Agency	014746	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649538950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE TORCH HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	110 W RANDOL MILL RD STE 242
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-4731
Country	:	US
Telephone Number	:	817-225-2160
Fax Number	:	817-225-2161

Provider Business Practice Location Address
First Line	:	110 W RANDOL MILL RD STE 242
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-4731
Country	:	US
Telephone Number	:	817-225-2160
Fax Number	:	817-225-2161

Authorized Official
Title or Position	:	RN/CEO/ADMINISTRATOR
Name	:	VIVIAN NGUM NGANG
Credential	:
Telephone Number	:	817-225-2160

Provider Enumeration Date	:	04/25/2012
Last Update Date	:	10/14/2024

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