# EXCELCARE BY DIVINEE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124443924
- **Authorized official:** MISS DIANE ROSE BROWN RN (PRESIDENT)
- **Authorized official phone:** (770) 443-2273

## Contact information

- **Practice address:** 284 SOMERSBY DR, DALLAS, GA 30157-8086
- **Practice address phone:** (770) 443-2273
- **Practice address fax:** (888) 883-4103
- **Mailing address:** 284 SOMERSBY DR, DALLAS, GA 30157-8086
- **Mailing address phone:** (770) 443-2273
- **Mailing address fax:** (888) 883-4103

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WH0200X | Home Health Registered Nurse | — | — | — |
| 164W00000X | Licensed Practical Nurse | — | — | — |
| 251B00000X | Case Management Agency | — | — | — |
| 251E00000X | Home Health Agency | — | — | — |
| 251F00000X | Home Infusion Agency | — | — | — |
| 251J00000X | Nursing Care Agency | — | — | — |
| 251S00000X | Community/Behavioral Health Agency | 110-R-0953 | GA | — |
| 253Z00000X | In Home Supportive Care Agency | — | — | Yes |
| 291U00000X | Clinical Medical Laboratory | — | — | — |
| 3140N1450X | Pediatric Skilled Nursing Facility | 110-R-0953 | GA | — |

## Other

- **Enumeration date:** 03/03/2014
- **Last updated:** 08/11/2021