Provider Demographics
NPI:1962524736
Name:DIVINE HEARTS HOME CARE
Entity type:Organization
Organization Name:DIVINE HEARTS HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHENITA
Authorized Official - Middle Name:DICKENS
Authorized Official - Last Name:BETHEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-977-3711
Mailing Address - Street 1:846 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-1706
Mailing Address - Country:US
Mailing Address - Phone:252-977-3711
Mailing Address - Fax:252-977-3211
Practice Address - Street 1:846 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-1706
Practice Address - Country:US
Practice Address - Phone:252-977-3711
Practice Address - Fax:252-977-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3518251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3418370Medicaid