MEDICARE: DIVINED HOME HEALTH CARE 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1679851380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINED HOME HEALTH CARE INC

Provider Business Mailing Address
First Line	:	28592 ORCHARD LAKE RD
Second Line	:	SUITE 360
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-2961
Country	:	US
Telephone Number	:	248-539-8047
Fax Number	:	248-539-8045

Provider Business Practice Location Address
First Line	:	28592 ORCHARD LAKE RD
Second Line	:	SUITE 360
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-2961
Country	:	US
Telephone Number	:	248-539-8047
Fax Number	:	248-539-8045

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AWATIF JAMIL
Credential	:
Telephone Number	:	248-539-8047

Provider Enumeration Date	:	07/29/2011
Last Update Date	:	09/01/2016

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