Provider Demographics
NPI:1316431547
Name:DIVICARE HOME HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:DIVICARE HOME HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:CHINYERE
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:469-583-9678
Mailing Address - Street 1:8005 N MACARTHUR BLVD APT 2017
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7648
Mailing Address - Country:US
Mailing Address - Phone:469-583-9678
Mailing Address - Fax:214-889-7700
Practice Address - Street 1:8005 N MACARTHUR BLVD APT 2017
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-7648
Practice Address - Country:US
Practice Address - Phone:469-583-9678
Practice Address - Fax:214-889-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-20
Last Update Date:2021-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty