MEDICARE: DIVINE HEALTH CARE 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	251E00000X	Home Health Agency	02940501	PA

General Provider Information

NPI Number	:	1790975571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE HEALTH CARE SERVICES, INC

Provider Business Mailing Address
First Line	:	6800 CASTOR AVE
Second Line	:	SUITE D
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-2106
Country	:	US
Telephone Number	:	215-745-8492
Fax Number	:	215-745-8482

Provider Business Practice Location Address
First Line	:	6800 CASTOR AVE
Second Line	:	SUITE D
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-2106
Country	:	US
Telephone Number	:	215-745-8492
Fax Number	:	215-745-8482

Authorized Official
Title or Position	:	ADMISTRATOR/DPS
Name	:	MRS. NORENE A ESSIEN-ETOKIMOH
Credential	:	RN
Telephone Number	:	215-745-8492

Provider Enumeration Date	:	07/27/2007
Last Update Date	:	07/27/2007

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