Provider Demographics
NPI:1285241968
Name:DIVINE HOME CARE PLUS LLC
Entity type:Organization
Organization Name:DIVINE HOME CARE PLUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:FELECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-907-1744
Mailing Address - Street 1:536 HARMONYVIEW CT
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-6233
Mailing Address - Country:US
Mailing Address - Phone:678-907-1744
Mailing Address - Fax:
Practice Address - Street 1:536 HARMONYVIEW CT
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-6233
Practice Address - Country:US
Practice Address - Phone:678-907-1744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health