Provider Demographics
NPI:1285407650
Name:DIVINE TREASURE HOME, LLC
Entity type:Organization
Organization Name:DIVINE TREASURE HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NKEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-283-2008
Mailing Address - Street 1:1432 HAMILTONS WAY
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-9027
Mailing Address - Country:US
Mailing Address - Phone:832-283-2008
Mailing Address - Fax:
Practice Address - Street 1:1432 HAMILTONS WAY
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-9027
Practice Address - Country:US
Practice Address - Phone:832-283-2008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health