Provider Demographics
NPI:1649800723
Name:DIVINE CHOICE HOME HEALTH AGENCY
Entity type:Organization
Organization Name:DIVINE CHOICE HOME HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FITZROY
Authorized Official - Middle Name:
Authorized Official - Last Name:COULSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-873-2021
Mailing Address - Street 1:PO BOX 1013
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32721-1013
Mailing Address - Country:US
Mailing Address - Phone:386-215-4299
Mailing Address - Fax:
Practice Address - Street 1:1229 BEXLEY CT
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-0846
Practice Address - Country:US
Practice Address - Phone:386-215-4299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-17
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty