Provider Demographics
NPI:1043046220
Name:DIVINE CARE HOME CARE SERVICES LLC
Entity type:Organization
Organization Name:DIVINE CARE HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAMIR
Authorized Official - Middle Name:H
Authorized Official - Last Name:COLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-954-5334
Mailing Address - Street 1:2047 CHANUPA CT
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-3817
Mailing Address - Country:US
Mailing Address - Phone:844-954-5334
Mailing Address - Fax:706-262-7888
Practice Address - Street 1:6150 WOODSIDE EXECUTIVE CT
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-3820
Practice Address - Country:US
Practice Address - Phone:844-954-5334
Practice Address - Fax:706-262-7888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care