Provider Demographics
NPI:1902520034
Name:DIVINE CARELINE HEALTH LLC
Entity Type:Organization
Organization Name:DIVINE CARELINE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:CU
Authorized Official - Last Name:DYKHENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-268-2182
Mailing Address - Street 1:2235 E FLAMINGO RD STE 136
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5189
Mailing Address - Country:US
Mailing Address - Phone:702-268-2182
Mailing Address - Fax:702-268-2185
Practice Address - Street 1:2235 E FLAMINGO RD STE 136
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5189
Practice Address - Country:US
Practice Address - Phone:702-268-2182
Practice Address - Fax:702-268-2185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNONEMedicaid