Provider Demographics
NPI:1447451398
Name:DEVINE HOME HEALTH CARE, LLC
Entity type:Organization
Organization Name:DEVINE HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, AND PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LETITIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-761-6508
Mailing Address - Street 1:PO BOX 2362
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24010-2362
Mailing Address - Country:US
Mailing Address - Phone:540-761-6508
Mailing Address - Fax:540-904-6878
Practice Address - Street 1:3739 SOUTHWAY DR SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-2265
Practice Address - Country:US
Practice Address - Phone:540-761-6508
Practice Address - Fax:540-904-6878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA374U00000X374U00000X
VA376K00000X376K00000X
VA372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Not Answered376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
Not Answered372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty