Provider Demographics
NPI:1902247430
Name:DIVINE HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:DIVINE HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MUCHENE
Authorized Official - Suffix:
Authorized Official - Credentials:RN/BSN
Authorized Official - Phone:614-432-6620
Mailing Address - Street 1:17801 111TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-6540
Mailing Address - Country:US
Mailing Address - Phone:614-432-6620
Mailing Address - Fax:
Practice Address - Street 1:17801 111TH AVE SE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-6540
Practice Address - Country:US
Practice Address - Phone:614-432-6620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care