MEDICARE: DIVINE FAITH HOME CARE SERVICES

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	N/A

General Provider Information

NPI Number	:	1659517423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE FAITH HOME CARE SERVICES

Provider Business Mailing Address
First Line	:	15310 WILDWOOD LAKE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-5524
Country	:	US
Telephone Number	:	281-568-5630
Fax Number	:	281-568-5630

Provider Business Practice Location Address
First Line	:	15310 WILDWOOD LAKE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-5524
Country	:	US
Telephone Number	:	281-568-5630
Fax Number	:	281-568-5630

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. EVELYN OKWUCHI JOSEPH
Credential	:
Telephone Number	:	832-215-6834

Provider Enumeration Date	:	12/29/2008
Last Update Date	:	12/29/2008

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