MEDICARE: DIVINE WELLNESS HOME HEALTH LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	3747P1801X	Personal Care Attendant
2	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
3	251B00000X	Case Management Agency
4	372600000X	Adult Companion
5	385HR2065X	Child Physical Disabilities Respite Care
6	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1760220156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE WELLNESS HOME HEALTH LLC.

Provider Business Mailing Address
First Line	:	1501 LAKE GROVE DR
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-8655
Country	:	US
Telephone Number	:	469-628-3606
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 LAKE GROVE DR
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-8655
Country	:	US
Telephone Number	:	945-289-5483
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ ADMINISTRATOR
Name	:	REMONICA LASHA WALLER
Credential	:
Telephone Number	:	945-289-5483

Provider Enumeration Date	:	07/18/2024
Last Update Date	:	04/07/2026

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