Provider Demographics
NPI:1730583154
Name:DIVINE HEALTH HOME CARE AGENCY, INC.
Entity type:Organization
Organization Name:DIVINE HEALTH HOME CARE AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-400-0849
Mailing Address - Street 1:9707 TRAVER ST
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1867
Mailing Address - Country:US
Mailing Address - Phone:202-400-0849
Mailing Address - Fax:866-405-4896
Practice Address - Street 1:9707 TRAVER ST
Practice Address - Street 2:
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721-1867
Practice Address - Country:US
Practice Address - Phone:202-400-0849
Practice Address - Fax:866-405-4896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health