Provider Demographics
NPI:1679160394
Name:DIVINE IN-HOME SERVICES LLC
Entity type:Organization
Organization Name:DIVINE IN-HOME SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-405-7502
Mailing Address - Street 1:7711 N OAK TRFY STE H
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-1763
Mailing Address - Country:US
Mailing Address - Phone:816-405-7502
Mailing Address - Fax:816-673-1172
Practice Address - Street 1:7711 N OAK TRFY STE H
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-1763
Practice Address - Country:US
Practice Address - Phone:816-405-7502
Practice Address - Fax:816-673-1172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty