Provider Demographics
NPI:1548494404
Name:DIVINE HOME CARE INC
Entity type:Organization
Organization Name:DIVINE HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:FLORINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:RN LIC # 146850
Authorized Official - Phone:910-904-2377
Mailing Address - Street 1:310 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-3297
Mailing Address - Country:US
Mailing Address - Phone:910-904-2377
Mailing Address - Fax:910-904-2477
Practice Address - Street 1:310 BIRCH ST
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-3297
Practice Address - Country:US
Practice Address - Phone:910-904-2377
Practice Address - Fax:910-904-2477
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIVINE HOMECARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-07
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2882251E00000X, 251B00000X, 253J00000X, 253Z00000X, 332B00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No253J00000XAgenciesFoster Care Agency
No253Z00000XAgenciesIn Home Supportive Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408217Medicaid