Provider Demographics
NPI:1962520635
Name:DIVINE HOME CARE, LLC
Entity type:Organization
Organization Name:DIVINE HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SERVICE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FLORINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:910-904-2377
Mailing Address - Street 1:751 S MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-3238
Mailing Address - Country:US
Mailing Address - Phone:910-904-2377
Mailing Address - Fax:910-904-2477
Practice Address - Street 1:751 S MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-3238
Practice Address - Country:US
Practice Address - Phone:910-904-2377
Practice Address - Fax:910-904-2477
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIVINE HOME CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-27
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC2882251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601209Medicaid