Provider Demographics
NPI:1144528845
Name:DIVINE GIFTS CARE SERVICES LLC
Entity type:Organization
Organization Name:DIVINE GIFTS CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GUILLORY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:281-773-1857
Mailing Address - Street 1:303 REMINGTON GREEN CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073-4392
Mailing Address - Country:US
Mailing Address - Phone:281-773-1857
Mailing Address - Fax:
Practice Address - Street 1:303 REMINGTON GREEN CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77073-4392
Practice Address - Country:US
Practice Address - Phone:281-773-1857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1548589286Medicaid