Provider Demographics
NPI:1871806364
Name:DEVINE HOLISTIC HOME HEALTH CARE INC
Entity type:Organization
Organization Name:DEVINE HOLISTIC HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:QUINNET
Authorized Official - Middle Name:
Authorized Official - Last Name:MOMOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-533-5163
Mailing Address - Street 1:3012 FAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-0443
Mailing Address - Country:US
Mailing Address - Phone:972-533-6163
Mailing Address - Fax:817-472-9046
Practice Address - Street 1:3012 FAIRVIEW DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-0443
Practice Address - Country:US
Practice Address - Phone:972-533-6163
Practice Address - Fax:817-472-9046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health