MEDICARE: DIVINE LIVING 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1962328260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE LIVING LLC

Provider Business Mailing Address
First Line	:	1303 S FRONTAGE RD # 171
Second Line	:
City	:	HASTINGS
State	:	MN
Zip	:	55033-2483
Country	:	US
Telephone Number	:	651-203-8772
Fax Number	:

Provider Business Practice Location Address
First Line	:	1303 S FRONTAGE RD # 171
Second Line	:
City	:	HASTINGS
State	:	MN
Zip	:	55033-2483
Country	:	US
Telephone Number	:	651-203-8772
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	CARISSA OZANGAR
Credential	:
Telephone Number	:	651-203-8772

Provider Enumeration Date	:	06/29/2026
Last Update Date	:	06/29/2026

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Directions to “DIVINE LIVING LLC ” Practice Location

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