Provider Demographics
NPI:1366578288
Name:DIVINEHEART HEALTHCARE, INC.
Entity type:Organization
Organization Name:DIVINEHEART HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NWACHUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-244-1837
Mailing Address - Street 1:10935 ESTATE LN STE 305
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-5157
Mailing Address - Country:US
Mailing Address - Phone:214-452-6253
Mailing Address - Fax:214-231-9072
Practice Address - Street 1:10935 ESTATE LN STE 305
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-5157
Practice Address - Country:US
Practice Address - Phone:214-452-6253
Practice Address - Fax:214-231-9072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2024-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009901251E00000X
251F00000X, 251J00000X, 3747P1801X
TX012309251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
677945Medicare Oscar/Certification