MEDICARE: DIVINE ROSE CARE LLC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1831820265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE ROSE CARE LLC

Provider Business Mailing Address
First Line	:	3114 BOUDINOT AVE UNIT 1
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-7006
Country	:	US
Telephone Number	:	513-580-6662
Fax Number	:

Provider Business Practice Location Address
First Line	:	3114 BOUDINOT AVE UNIT 1
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-7006
Country	:	US
Telephone Number	:	513-580-6662
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT/ADMINISTRATOR
Name	:	MR. DANIEL ADDAI
Credential	:
Telephone Number	:	513-580-6662

Provider Enumeration Date	:	06/17/2022
Last Update Date	:	06/17/2022

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