Provider Demographics
NPI:1285450981
Name:DIVINE GENTLE CARE LLC
Entity type:Organization
Organization Name:DIVINE GENTLE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:985-241-1836
Mailing Address - Street 1:2620 ALMEDA GENOA RD APT 2301
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77047-0026
Mailing Address - Country:US
Mailing Address - Phone:985-241-1836
Mailing Address - Fax:
Practice Address - Street 1:2620 ALMEDA GENOA RD APT 2301
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77047-0026
Practice Address - Country:US
Practice Address - Phone:985-241-1836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care