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Organization
DIVINE HOME CARE CHANGES
Active
Organization
DIVINE HOME CARE CHANGES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHASITY DAVIS (CEO)
(919) 339-1854
Entity
Organization
Contact information
Practice address
106 ETHEL DR, VICKSBURG, MS 39180-8905
(919) 339-1854
Mailing address
PO BOX 821878, VICKSBURG, MS 39182-1878
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
07/23/2020
Last updated
10/07/2022
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