Provider Demographics
NPI:1215177332
Name:DIVINE HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:DIVINE HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:MUCHENE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:614-432-6620
Mailing Address - Street 1:3375 VALLEY PARK AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-6123
Mailing Address - Country:US
Mailing Address - Phone:614-432-6620
Mailing Address - Fax:614-470-9676
Practice Address - Street 1:3375 VALLEY PARK AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-6123
Practice Address - Country:US
Practice Address - Phone:614-432-6620
Practice Address - Fax:614-470-9676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health