Provider Demographics
NPI:1306563812
Name:DIVINE TOUCH HEALTHCARE PROFESSIONALS LLC
Entity type:Organization
Organization Name:DIVINE TOUCH HEALTHCARE PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MAXWELL
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROCKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-446-1610
Mailing Address - Street 1:4432 SCARBOROUGH SQ
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-1232
Mailing Address - Country:US
Mailing Address - Phone:571-446-1610
Mailing Address - Fax:
Practice Address - Street 1:4432 SCARBOROUGH SQ
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22309-1232
Practice Address - Country:US
Practice Address - Phone:571-446-1610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health