Provider Demographics
NPI:1861702698
Name:INSPIRED DIVINELY HEALTH CARE, LLC
Entity type:Organization
Organization Name:INSPIRED DIVINELY HEALTH CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ARDELLE
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN;BSN
Authorized Official - Phone:817-561-2020
Mailing Address - Street 1:6700 WAGONET RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILL
Mailing Address - State:TX
Mailing Address - Zip Code:76140-1344
Mailing Address - Country:US
Mailing Address - Phone:817-561-2020
Mailing Address - Fax:817-561-2041
Practice Address - Street 1:6700 WAGONET RD.
Practice Address - Street 2:
Practice Address - City:FOREST HILL
Practice Address - State:TX
Practice Address - Zip Code:76140-1344
Practice Address - Country:US
Practice Address - Phone:817-561-2020
Practice Address - Fax:817-561-2041
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INSPIRED DIVINELY HEALTH CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health